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).

Used for Hypnotic, sedative, antiepileptic or anticonvulsant, antianxiety, muscle relaxant and alcohol withdrawal
Dosage forms Tablets, Oral disintegrating (dissolving) tablet, Oral solution
Available Strengths 0.5mg, 1mg, 2mg, 0.125mg, 0.25mg, 0.5mg.
0.5mg/5ml, 2mg/5ml oral solution (for pediatrics)
Method of administration Taken with or without food orally
Prescription Required
Alternatives Klonopin, Azepic, Clonafit, Clonamed, Clonotril, Clozep, Epitril, Epizam, Lonazep,Melzap, Norep,Ozepam, Sezolep
Pharmacokinetics Onset of action : 30 to 40 minutes
Duration of action 6 to 8 hours in adults and 12 hours in children

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.

Type of cancer
Dose of clonazepam (mg/day)
Ovarian
1mg
Cervical
0.5mg
Breast
2mg
Lung
2mg

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

Brand name Manufacturer
Klonopin Roche pharmaceuticals
Clonafit Mankind
Clonamed Medi health
Clonotril Torrent pharma
Clozep Elite Pharma
Epitril Novartis Pharma
Lonazep Sun Pharma
Epizam Cipla Limited
Norep Mankind
Melzap Alkem
Ozepam Ipca laboratories
Sezolep Wockhardt

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?

Clonazepam
Lorazepam
It is generally used for seizers and panic disorders It is generally used for anxiety disorders
Taken in two to three divided doses Taken in three to four divided doses
Its brand name is klonopin Its brand name is Ativan
Manufactured by Roche pharmaceuticals Manufactured by Baxter pharmaceuticals
Available dosage forms are tablets and dissolving tablets Available dosage forms are tablets, Injection and liquid.
It has less withdrawal symptoms It causes withdrawal symptoms more likely.

Differences between clonazepam and Xanax?

Clonazepam
Xanax
Not only treats anxiety but also treats pain associated with neuralgia, Bipolar disorder (disorder associated with mood changes). Not only treats anxiety but also Irritable bowel syndrome, cancer pain
Its brand name is klonopin It’s a brand of Alprazolam
Manufactured by Roche pharmaceuticals Manufactured by Pfizer
Available dosage forms are tablets and dissolving tablets Available dosage forms are Immediate release tablets, Extended release tablets, Solution, Injection and liquid.
This does not have extended release tablets. This prolongs the action of the drug and thereby reducing the frequency of taking the tablets.
It has more side effects than Xanax It has fewer side effects.
Also, read our article on –  Modalert – Uses, Dosage, Precautions, Interactions

References

Posted by V.L.Priyanka

V.L.Priyanka is a registered pharmacist with more than 5+ Years of experience in Research & Development in leading Pharmaceutical Industries. Also, she is a Technical Editor and Founder of a medical information oriented blog. She completed masters in Pharmacy.

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