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Clonazepam

Clonazepam, a benzodiazepine, is available as scored tablets with a K-shaped perforation containing 0.5 mg of clonazepam and unscored tablets with a K-shaped perforation containing 1 mg or 2 mg of clonazepam. Each tablet also contains lactose, magnesium stearate, microcrystalline cellulose and corn starch, with the following colorants: 0.5 mg—FD&C Yellow No. 6 Lake; 1 mg—FD&C Blue No. 1 Lake and FD&C Blue No. 2 Lake.

Clonazepam is also available as an orally disintegrating tablet containing 0.125 mg, 0.25 mg, 0.5 mg, 1 mg or 2 mg clonazepam. Each orally disintegrating tablet also contains gelatin, mannitol, methylparaben sodium, propylparaben sodium and xanthan gum.

Chemically, clonazepam is 5-(2-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has a molecular weight of 315.72 and the following structural formula:

Clonazepam prescription:

Clonazepam may be prescribed for:
* Epilepsy
* Anxiety disorders
* Panic disorder
* Initial treatment of mania or acute psychosis together with firstline drugs such as lithium, haloperidol or risperidone[8][9]
* Hyperekplexia
* Bruxism
* Restless legs syndrome and some other forms of parasomnia
* Rapid eye movement behavior disorder (low doses)
* The treatment of acute and chronic akathisia
* Use as a muscle relaxant (off-label use)
* Use as a sedative for sleep (off-label use). Its long half-life sometimes makes it useful for treating middle-of-the-night insomnia (waking up too early) but may also lead to next-day effects.
* Essential tremor (off-label use)
* Can also be used to relax bladder neck tightness to improve symptoms of benign prostatic hyperplasia (BPH).

The effectiveness of clonazepam in the short-term treatment of panic disorder has been demonstrated in controlled clinical trials. Some long-term trials have suggested a benefit of clonazepam for up to 3 years without the development of tolerance but these trials were not placebo controlled. Clonazepam is also effective in the management of acute mania.

Clonazepam is sometimes used for refractory epilepsies; however, long-term prophylactic treatment of epilepsy has considerable limitations, the most notable ones being the loss of antiepileptic effects due to tolerance, which renders the drug useless with long-term use, and side-effects such as sedation, which is why clonazepam and benzodiazepines as a class should, in general, be prescribed only for the acute management of epilepsies.

Clonazepam or diazepam has been found to be effective in the acute control of nonconvulsive status epilepticus. However, the benefits tended to be transient in many of the patients, and the addition of phenytoin for lasting control was required in these patients.

In general, Clonazepam has been found to be ineffective in the control of infantile spasms. Clonazepam is less effective and potent as an anticonvulsant in bringing infantile seizures under control compared with nitrazepam in the treatment of West syndrome, which is an age-dependent epilepsy affecting the very young. However, as with other epilepies treated with benzodiazepines, long-term therapy becomes ineffective with prolonged therapy, and the side effects of hypotonia and drowsiness are troublesome with clonazepam therapy; other antiepileptic agents are, therefore, recommended for long-term therapy, possibly Corticotropin (ACTH) or vigabatrin. Furthermore, Clonazepam is not recommended for widespread use in the management of seizures related to West syndrome.

Clonazepam has shown itself to be highly effective as a short-term (3 weeks) adjunct to SSRI treatment in obsessive-compulsive disorder and clinical depression in reducing SSRI side effects with the combination being superior to SSRI treatment alone in a study funded by the manufacturers of Clonazepam,.

Clonazepam Dosage

SEIZURE DISORDERS
Adults
The starting dose should be no more than 1.5 milligrams per day, divided into 3 doses. Your doctor may increase your daily dosage by 0.5 to 1 milligram every 3 days until your seizures are controlled or the side effects become too bothersome. The most you should take in 1 day is 20 milligrams.

Children
The starting dose for infants and children up to 10 years old or up to 66 pounds should be 0.01 to 0.03 milligram—no more than 0.05 milligram—per 2.2 pounds of body weight daily. The daily dosage should be given in 2 or 3 smaller doses. Your doctor may increase the dose by 0.25 to 0.5 milligram every 3 days until seizures are controlled or side effects become too bad. If the dose cannot be divided into 3 equal doses, the largest dose should be given at bedtime. The maximum maintenance dose is 0.1 to 0.2 milligram per 2.2 pounds daily.

PANIC DISORDER
Adults
The starting dose is 0.25 milligram twice a day. After 3 days, your doctor may increase the dose to 1 milligram daily. Some people need as much as 4 milligrams a day.
Children
For panic disorder, safety and effectiveness have not been established in children under age 18.
Older Adults
Clonazepam tends to build up in the body if the kidneys are weak—a common problem among older adults. Higher doses of the drug also tend to cause more drowsiness and confusion in older patients. People over age 65 are therefore started on low doses of Clonazepam and watched with extra care.

Clonazepam side effects

Common Clonazepam side effects:
* Drowsiness
* Impairment of cognition, judgment, or memory
* Irritability and aggression
* Psychomotor agitation
* Lack of motivation
* Loss of libido
* Impaired motor function
* Impaired coordination
* Impaired balance
* Dizziness
* Diarrhea
* Cognitive impairments
* Increased sleepwalking (If used in treatment of sleepwalking)
* Auditory hallucinations
* Short-term memory loss
* Anterograde amnesia (common with higher doses)
* Some users report hangover-like symptoms of being drowsy, having a headache, being sluggish, and being irritable after waking up if the medication is taken before sleep. This is likely the result of the medication’s long half-life, which continues to affect the user after waking up, as well as its disruption of the REM cycle.

Occasional Clonazepam side effects
* Serious dysphoria
* Thrombocytopenia
* Serious psychological and psychiatric side-effects
* Induction of seizures or increased frequency of seizures
* Personality changes
* Behavioural disturbances

Rare Clonazepam side effects
* Psychosis
* Incontinence
* Liver damage
* Paradoxical behavioural disinhibition (most frequently in children, the elderly, and in persons with developmental disabilities)
* Rage
* Excitement
* Impulsivity

Long term Clonazepam side effects

The long term effects of clonazepam can include; depression, disinhibition and sexual dysfunction.

Withdrawal-related Clonazepam side effects

* Anxiety, irritability, insomnia
* Panic attacks, tremor
* Seizures similar to delirium tremens (with long-term use of excessive doses)

Benzodiazepines such as clonazepam can be very effective in controlling status epilepticus, but, when used for longer periods of time, serious side-effects may develop, such as interference with cognitive functions and behavior. Many individuals treated on a long-term basis develop a form of dependence known as “low-dose dependence,” as was shown in one double-blind, placebo-controlled study of 34 therapeutic low-dose benzodiazepine users — physiological dependence was demonstrated via flumazenil-precipitated withdrawal.Use of alcohol or other CNS depressants while taking clonazepam greatly intensifies the effects (and side-effects) of the drug. Side-effects of the drug itself are generally benign, but sudden withdrawal after long-term use can cause severe, even fatal, symptoms.

Clonazepam overdose

An individual who has consumed too much clonazepam may display one or more of the following symptoms:

* Coma
* Hypotension
* Impaired motor functions
* Impaired reflexes
* Impaired coordination
* Impaired balance
* Dizziness
* Labored breathing
* Mental confusion
* Somnolence (difficulty staying awake)
* Nausea

Coma can be cyclic with the individual alternating from a comatose state to a hyperalert state of consciousness, as occurred in a 4-year-old boy who suffered an overdose of clonazepam. The combination of clonazepam and certain barbiturates eg amobarbital at prescribed doses has resulted in a synergistic potentiation of the effects of each drug leading to serious respiratory depression.