Clonazepam – Uses, Side effects, Precautions

Clonazepam is a derivative of Benzodiazepines which treats various types of seizures (fits) i.e typical absence (fits appear suddenly and go off), infantile myoclonic (jerks caused by sudden muscle contractions in children), atypical absence (resulting in sudden loss of attention), myoclonic (jerks caused by sudden muscle contractions) and akinetic seizures (complete loss of muscle tone).

Uses

• Clonazepam is used to control seizures (fits), panic attacks (feeling that something bad is going to happen and attacks of fear).
• For the relief of anxiety.
• For treatment of certain type of seizers (petit mal seizures or absence seizers, akinetic seizers and myoclonic seizers).
• For treating restless leg syndrome.(uncomfortable sensations on legs)

So far there is no evidence about clonazepam for the treatment of Cancer pain, however, there is a case study conducted where clonazepam is used for cancer related neuropathic pain.

Doses upto 8mg can be used for treatment for cancer pain but patients observed drowsiness when taken high doses.

Dosage

For seizers –

In adults -1.5mg daily in divided doses.

In children, up to 10 years of age 0.01mg is orally administered in 2 or 3 divided doses.

For panic disorders – 0.25mg twice daily and maximum dose up to 4mg.

The maximum daily dose is 20mg.

It should not be stopped immediately. The dose should be gradually reduced over a period of time under the supervision of Doctor.

If it is used regularly for a longer period of time in high doses it causes withdrawal reactions. Symptoms include increase of fits, psychosis, shaking, muscle and stomach cramps. Doctor will reduce the dose if withdrawal reactions occur.

Due to the high risks, this drug is usually used for a short period of time and in combination with other drugs such as antidepressants (used to treat depression).

Overdosage

• It results in cardiorespiratory depression.
• If Clonazepam is not used properly it causes physical and psychological dependence, suicidal thoughts, worsening of depression, sleep disorders.

Missed a dose?

You should take the missed dose of a tablet as soon as you remember, don’t take the tablet if it is the nearer time of your next dose. Skip the missed dose and take them as usual from the next day

Different brands of Clonazepam

How it acts

• It is a CNS (Central nervous system) depressant.
• Clonazepam increases the effect of GABA (Gamma amino butyric acid).GABA is a neurotransmitter in the brain which decreases the brain activity. As a result of this anxiety and other psychiatric disorders occur. So by taking drugs that increase the effect of GABA, we can prevent anxiety, panic attacks, and a certain type of seizers.

Interactions

• An interaction that leads to death occurs in combination with oxycodone (an opioid).
• It interacts with other drugs used to treat anxiety such as buspirone and hydroxyzine and causes severe drowsiness.
• It interacts with other drugs used to treat seizures such as gabapentin, pregabalin.
• Also interacts with Tricyclic antidepressants such as Nortriptyline and amitriptyline.
• It interacts with orlistat, sodium oxybate, cough relievers (codeine, hydrocodiene), drugs for sleep (alprazolam, zolpidem etc.). Combination with these drugs increases side effects of drowsiness and breathing problems.

Side effects

Here are some common side effects of clonazepam.

• Tiredness
• Increased saliva
• Loss of coordination
• Sleep disturbances
• Confusion
• Amnesia (loss of memory)
• Fainting

Here are some serious side effects with clonazepam.

• Suicidal thoughts
• Depression
• Seizures
• Memory impairment
• Drug Dependency & addiction

Behavioral side effects such as aggression, agitation, hyperactivity, irritability

Warnings

• If you use this drug with other combination of this class of drugs i.e benzodiazepines it causes sedation, respiratory depression, coma, and death.
• It causes Central nervous system depression so patients who are taking this medicine should avoid operating heavy machinery & driving.
• As it increases drowsiness and dizziness avoid alcohol intake or marijuana products while using this medicine.
• Patients who are taking this medicine should be closely monitored as it increases depression, suicidal thoughts and for any unusual changes in mood or behavior.

Precautions

Before taking Clonazepam tell your Doctor that

• You are allergic to it and other benzodiazepines such as diazepam and lorazepam.
• You have eye problems (Narrow angle glaucoma)

Pharmacokinetics

Absorption

After oral administration, it is rapidly and completely absorbed and reaches the blood circulation within 1 to 4 hours.

Distribution

Most of the drug after entering the body, 85% of it binds to plasma proteins.

Elimination

• It is metabolized by liver enzymes (CYP 450) and 2% of it is excreted as unchanged clonazepam in urine.
• Half of the drug is eliminated from the body within 30-40hrs.

FAQ’S

Does clonazepam is used for treating childhood anxiety disorders??

Yes it is used to treat childhood anxiety disorders but side effects like drowsiness have been reported.

 Can a pregnant women take this medicine?

As this drug causes adverse risks to fetus so avoid during pregnancy.

Is Clonazepam a controlled substance?

It is a controlled substance due to its addiction potential.

Does clonazepam cause Dependence and abuse?

Yes it can cause Dependence and abuse if you use for a long period and in higher doses.

Does Clonazepam causes anxiety?

No it doesn’t cause anxiety, infact it reduces anxiety. However if you misuse this drug it causes dependency and causes one of side effect anxiety.

Differences between Clonazepam and Lorazepam?

Differences between clonazepam and Xanax?

Also, read our article on –  Modalert – Uses, Dosage, Precautions, Interactions

References

• Clonazepam –FDA-Orangebook
• Clonazepam –FDA prescribing information
• A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period – Volume 95, Issue 9 march 2016.
• The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study – Clin Psychopharmacol Neurosci. 2016 May; 14(2): 177–183
• Clonazepam as an adjuvant analgesic in patients with cancer-related neuropathic pain – December 2003Volume 26, Issue 6, Pages 1073–1074
• Journal of the American Academy of Child & Adolescent Psychiatry – Volume 33, Issue 3, March–April 1994, Pages 372-376

• Category: CNS Drugs