Klonopin (clonazepam) dosing, indications, interactions, adverse

4.20.2018 | Evan Carey

The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms.

Upper respiratory infection (5-10%) Confusion (1-5%) Dysarthria (1-5%) Rhinitis (1-5%) Coughing (1-5%) Urinary frequency (1-5%) Impotence (1-5%) Decreased libido (1-5%) Increased salivation Worsening tonic-clonic seizures.

There are no adequate and well-controlled studies of Klonopin in pregnant women; available human data on risk of teratogenicity are inconclusive; there is insufficient evidence in humans to assess effect of benzodiazepine exposure during pregnancy on neurodevelopment; administration of benzodiazepines immediay prior to or during childbirth can result in a syndrome of hypothermia, hypotonia, respiratory depression, and difficulty feeding; in addition, infants born to mothers who have taken benzodiazepines during later stages of pregnancy can develop dependence, and subsequently withdrawal, during the postnatal period.

Effects on breastfed infant and on milk production are unknown; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition.

Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicidal ideation.

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B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

Klonopin (clonazepam) dosing, indications, interactions, adverse

Half-life: 17-60 hr (adults); 22-33 hr (children) Excretion: Urine.

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1.5 mg/day PO divided q8hr; increase by 0.5-1 mg q3Days until desired effect achieved; not to exceed 20 mg/day.

Maintenance: 2-8 mg PO; not to exceed 20 mg/day.

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processing. Drugs & Diseases clonazepam (Rx) Brand and Other Names: Klonopin Classes: Anticonvulsants, Benzodiazepine ; Antianxiety Agents ; Anxiolytics, Benzodiazepines Share Print Feedback Close Facebook Twitter LinkedIn Google+ Sections clonazepam (Rx) Sections clonazepam Dosing & Uses Interactions Adverse Effects Warnings Pregnancy Pharmacology Images Patient Handout Formulary Dosing & Uses Adult Pediatric Dosage Forms & Strengths tablet dispersible: Schedule IV tablet: Schedule IV.

X: Do not use in pregnancy. Safer alternatives exist. Risks involved outweigh potential benefits.

<10 years or <30 kg.

NA: Information not available.

Increased risk of suicidal thoughts/behavior reported with antiepileptic agents; monitor patient for suicidal behavior and notify health-care provider immediay.

Discontinuation of treatment: Withdraw treatment gradually; decrease the dose q3Days by 0.125 mg PO q12hr until compley withdrawn Orphan indication sponsor Administration: Intranasal spray Orphan indication sponsor.

Anterograde amnesia reported benzodiazepine use.

Hyperactive or aggressive behavior reported with benzodiazepines in pediatric/adolescent patients and in psychiatric patients.

The American Academy of Neurology guidelines includes use of clonazepam for short-term treatment (~3 mo) to decrease tardive dyskinesia symptoms.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

Use with caution in patients with compromised respiratory function.

Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day tablet: Schedule IV <6 years.

Alternatively, 1 mg topirally three times daily after each meal; suck on the tablet, retain salive in mouth near pain sites without swallowing for 3 min, then expectorate saliva.

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0.5 mg PO at bedtime; increase dose by 0.5 mg q3-4days; not to exceed 6 mg/day.

Withdraw gradually when used for panic disorder.

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Use with caution in patients with a history of drug abuse or acute alcoholism; drug dependency possible; prolonged use may result in psychological and physical dependence.

Positive evidence of human fetal risk. D: Use in LIFE-THREATENING emergencies when no safer drug available.

≥10 years or ≥30 kg Discontinuation of treatment No Results Somnolence (37%) Abnormal coordination (5-10%) Ataxia (5-10%) Depression (5-10%) Dizziness (5-10%) Fatigue (5-10%) Memory impairment (5-10%).

May produce increase in salivation; consider before giving drug to patients who have difficulty handling secretions.

May have porphyrogenic effect; use with caution in patients with porphyria.

Data for other benzodiazepines suggest possibility of adverse developmental effects (long-term effects on neurobehavioral and immunological function) in animals following prenatal exposure to benzodiazepines.

Not recommended in patients with depressed neuroses, psychotic reactions, severe respiratory depression, myasthenia gravis (allowable in limited circumstances), acute alcohol intoxication.

May cause CNS depression and impairs ability to perform hazardous tasks.

No Results No Results.

Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation Significant hepatic impairment Documented hypersensitivity.

Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. From: To:. The above information is provided for general informational and educational purposes only.

Renal impairment: Supplemental dose in hemodialysis not necessary.

Initial: 1 mg/day PO; adjust dose based on response and tolerability by 1 mg/day increments q3-4 days; not to exceed 4.5 mg/day.

Acute narrow angle glaucoma.

Peak plasma time: 1-4 hr; 5-7 days (steady state) Protein bound: 85% Vd: 1.5-3 L/kg.

Suppresses the spike-and-wave discharge in absence seizures by depressing nerve transmission in motor cortex Bioavailability: 90% Onset: 20-40 min.

Long-acting benzodiazepine that increases the presynaptic GABA inhibition and reduces the monosynaptic and polysynaptic reflexes. Suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters.

0.25 mg PO q12hr initially; may increase to 1 mg/day after 3 days (up to 4 mg/day in some patients).

Metabolized by CYP3A4 (minor), glucuronic acid conjugation Metabolites: Inactive.

Paradoxical reactions, such as agitation, irritability, aggression, anxiety, anger, nightmares, hallucinations, and psychoses may occur when using benzodiazepines; discontinue therapy, should this occur; paradoxical reactions are more likely to occur in children and in the elderly.

0.25 mg PO at bedtime for 1 week; increase dose by up to 0.25 mg qweek; not to exceed 3 mg daily in 3 divided doses.

Controlled studies in pregnant women show no evidence of fetal risk. A: Generally acceptable.

When used in patients in whom several different types of seizure disorders coexist, clonazepam may increase incidence or precipitate onset of generalized tonic-clonic seizures (grand mal); may require addition of appropriate anticonvulsants or increase in dosages; concomitant use of valproic acid and clonazepam may produce absence status.

Abrupt withdrawal, particularly in patients on long-term, high-dose therapy, may precipitate status epilepticus; when discontinuing clonazepam, gradual withdrawal essential; while being gradually withdrawn, simultaneous substitution of another anticonvulsant may be indicated.

0.25-2 mg PO 30 min prior to bedtime; not to exceed 4 mg.

In some studies, up to 30% of patients who initially responded have shown a loss of anticonvulsant activity, often within 3 months of administration; in some cases, dosage adjustment may reestablish efficacy.

Not for concomitant administration with alcohol or other CNS-depressant drugs.