Clonazepam chemical structure
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Clonazepam

Clonazepam (marketed by Roche under the trade-name Klonopin® in the United States and Rivotril® in Canada and Europe) is a drug which is a benzodiazepine derivative. It is a highly potent and powerful sedative, hypnotic, anticonvulsant, amnestic and anxiolytic. more...

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Pharmacology

Like other benzodiazepines, clonazepam is believed to act by simulating the action of GABA on the central nervous system. Because of strong anxiolytic properties and euphoriant side-effects it is said to be among the class of 'highly potent' benzodiazepines with a higher risk of abuse, misuse and dependence than other benzodiazepines. The sedative effects of Clonazepam are relatively weak, compared to its strong anxiolytic and anticonvulsant effects. One quarter of a milligram (0.25mg) of Clonazepam is equivalent to five milligrams (5.00mg) of Diazepam.

Indications

Clonazepam is commonly prescribed for:

  • Epilepsy
  • Anxiety disorder
  • Panic attacks
  • Restless leg syndrome (RLS)
  • Inital treatment of mania, together with firstline-drugs such as lithium, haloperidol or risperidone
  • Hallucinogen persisting perception disorder (off-label use)
  • Chronic fatigue syndrome
  • Night terrors

Clonazepam is rarely used as a treatment for insomnia, because its sedative effects are relatively weak compared to other benzodiazepines.

Availability

Clonazepam was approved in the United States as a generic medication in 1997 and is now manufactured and marketed by several companies.

Clonazepam is available in the following forms:

  • Tablets: 0.25, 0.5, 1.0, and 2mg
  • Liquid concentrate: 2.5mg per ml
  • Oral wafers: 0.25, 0.5, 1.0 mg
  • Injection concentrate: 1mg per ml

Dosage

Epilepsy

Status epilepticus - 1mg is given slowly by I.V.; if seizures persist additional doses of 1mg may be given in intervals of 10 to 20 minutes.

Clonazepam can be useful for long-term treatment of some petit-mal forms of epilepsy in children and adolescents (adults may also respond well).

Up to 30% of epileptic patients treated with clonazepam develop a serious tolerance to the anticonvulsant effects. This may require dose increases or gradual withdrawal and replacement of the drug.

Oral doses in long term treatment of epilepsy vary from 1mg to 20mg, depending upon the severity of case and the weight of the patient. Treatment should be initiated at a low dose, and can be increased gradually if necessary.

Other

  • Anxiety and panic disorders - 1mg to 10mg daily, in divided doses
  • Restless Leg Syndrome - 1mg to 2mg at bedtime
  • Mania - Up to 20mg daily, in divided doses

Side Effects

Because Clonazepam can impair both mental and motor function, those taking it are advised to use caution when operating motor vehicles or machinery, or engaging in hazardous occupations requiring mental alertness. Side effects include:

Read more at Wikipedia.org


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A Little Clonazepam Goes a Long Way in CFS
From Family Pratice News, 5/15/01 by Sherry Boschert

SAN FRANCISCO -- Small doses of clonazepam may reduce neurally mediated symptoms in patients with chronic fatigue syndrome, a small uncontrolled trial suggests.

Neurally mediated symptoms declined in 13 patients who were treated with 0.25-0.75 mg/day (a mean of 0.41 mg/day) of clonazepam. Prospective, placebo-controlled trials are needed to confirm these findings, Dr. Tom T. Hee said in a poster presentation at the annual meeting of the American College of Chest Physicians.

All of the patients had been diagnosed with chronic fatigue syndrome and were referred to the cardiac center at Creighton University, Omaha, Neb., for neurally mediated symptoms including orthostatic presyncope in eight patients and weakness, exercise intolerance, and inability to participate in normal day-to-day activities in all 13 patients, said Dr. Hee of the university.

On clonazepam, the frequency of orthostatic presyncope decreased from daily episodes to 0-2 episodes per month in seven (88%) of eight patients with the symptom. Symptoms as a whole declined enough in 12 patients (92%) that they were able to resume their normal lifestyles.

The symptoms were reproduced by head-up tilt table tests in 10 of 13 patients before treatment with clonazepam. After treatment, one patient continued to have abnormal head-up tilt table results, six had normal results, and three showed some improvement in their ability to tolerate the tilt table for longer periods.

All patients experienced significant early morning sedation when they started using clonazepam. Later side effects included noncardiac chest discomfort in one patient and excessive sedation in two patients that subsided when the dosage was reduced.

The cohort included 10 females and 3 males aged 14-53 years.

Clonazepam should be added to the list of potentially useful therapies to treat neurocardiogenic syncope--[beta]-blockers, selective serotonin reuptake inhibitors, disopyramide, and volume expansion, Dr. Hee said.

COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group

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