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Pharmacologic class: Benzodiazepine
Therapeutic class: Anticonvulsant
Controlled substance schedule IV
Pregnancy risk category D
Unknown. May enhance activity of gamma-aminobutyric acid, an inhibitory neurotransmitter in CNS.
Tablets: 0.5 mg, 1 mg, 2 mg
Indications and dosages
➣ Absence seizures (Lennox-Gastaut syndrome); akinetic and myoclonic seizures
Adults: Initially, 1.5 mg/day P.O. in three divided doses; may increase by 0.5 to 1 mg q 3 days until seizures are adequately controlled or drug intolerance occurs. Maximum dosage is 20 mg/day.
Infants and children ages 10 and younger or weighing 30 kg (66 lb) or
less: Initially, 0.01 to 0.03 mg/kg/day P.O. Give total dosage (not to exceed 0.05 mg/kg/day) in two to three equally divided doses. Increase by no more than 0.25 to 0.5 mg q 3 days until dosage of 0.1 to 0.2 mg/kg/day is reached, seizures are adequately controlled, or drug intolerance occurs.
• Acute manic episodes of bipolar disorder
• Multifocal tic disorders
• Parkinsonian dysarthria
• Periodic leg movements occurring during sleep
• Adjunctive treatment of schizophrenia
• Hypersensitivity to drug or other benzodiazepines
• Severe hepatic disease
• Acute angle-closure glaucoma
Use cautiously in:
• renal impairment, chronic respiratory disease, open-angle glaucoma
• history of porphyria
• pregnant or breastfeeding patients
☞ Be aware that overdose may cause fatal respiratory depression or cardiovascular collapse.
• Give tablets with water, and make sure patient swallows them whole.
CNS: ataxia, fatigue, drowsiness, behavioral changes, depression, dizziness, nervousness, reduced intellectual ability
EENT: abnormal eye movements, blurred vision, diplopia, nystagmus, sinusitis, rhinitis, pharyngitis
GI: constipation, diarrhea, hypersalivation
GU: dysuria, nocturia, urinary retention, dysmenorrhea, delayed ejaculation, erectile dysfunction
Hematologic: anemia, eosinophilia,
Respiratory: increased respiratory secretions, upper respiratory tract infection, cough, bronchitis, respiratory depression
Other: appetite changes, fever, physical or psychological drug dependence, drug tolerance, allergic reaction
Drug-drug. Antidepressants, antihistamines, opioids, other benzodiazepines: additive CNS depression
Barbiturates, rifampin: increased metabolism and decreased efficacy of clonazepam
Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased clonazepam metabolism
Phenytoin: decreased clonazepam blood level
Drug-diagnostic tests. Eosinophils, liver function tests: increased values
Platelets, white blood cells: decreased counts
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
• Monitor patient for respiratory depression. Assess respiratory rate and quality, oxygen saturation (using pulse oximetry), and mental status.
• Monitor hematologic and liver function test results.
☞ Instruct patient to immediately report easy bleeding or bruising or yellowing of skin or eyes.
• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
☞ Caution patient not to stop taking drug abruptly. Advise him to consult prescriber for dosage-tapering schedule if he wishes to discontinue drug.
• Advise patient not to drink alcohol, which may increase drowsiness, dizziness, and risk of seizures.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.