Clonazepam is an antiepileptic drug from the group of benzodiazepine derivatives, which has a pronounced anticonvulsant, anxiolytic, central muscle relaxant, sedative and hypnotic effect.
Release form and composition
Dosage form Clonazepam - tablets (10 or 30 pieces in blisters, 3 or 1 pack in a carton box, respectively).
The active ingredient of the drug is clonazepam. The content in 1 tablet is 0.5 or 2 mg.
Indications for use
- As a means of series I, epilepsy in adults and children, including infants: atonic seizures (“drop-attack” or “fall” syndrome), nodative convulsions, typical (petit mal) and atypical (Lennox-Gastaut syndrome) absences ;
- As a means of II series - infantile spasms (West syndrome);
- As a means of III row - tonic-clonic convulsions (grand mal), simple / complex secondary-generalized tonic-clonic convulsions and partial seizures.
In addition, the drug is prescribed in the following cases:
- Psychomotor agitation;
- Panic disorders;
- Manic phase of cyclotymy;
- Syndromes of paroxysmal fear and phobias (in patients over 18 years old);
- Insomnia (especially in patients with organic brain damage);
- Muscle hypertonus;
- Alcohol withdrawal syndrome (tremor, acute agitation, hallucinations, acute alcohol or delirium tremens).
- Myasthenia gravis;
- Acute attack of angle-closure glaucoma or predisposition to the disease;
- Acute respiratory failure;
- Severe chronic obstructive pulmonary disease (progression of respiratory failure is possible);
- Depression of the respiratory center;
- Severe depression (suicidal tendencies are possible);
- Acute alcohol intoxication, accompanied by a weakening of vital functions;
- Acute poisoning with hypnotic drugs or narcotic analgesics;
- Impairment of consciousness;
- Lactation period;
- Age up to 18 years in the treatment of paroxysmal fear;
- Hypersensitivity to the drug.
Clonazepam is prescribed with special care for the elderly, patients with severe liver disease, ataxia, episodes of sleep apnea, severe chronic respiratory failure (especially during a period of acute deterioration).
Dosing and Administration
Clonazepam should be taken orally.
Doses in each case are selected individually. The initial daily dose for adults is no more than 1 mg, the elderly - no more than 0.5 mg. Maintenance dose - 4-8 mg per day.
The initial dose for children up to 5 years (including infants) is not more than 0.25 mg, for children 5-12 years old - 0.5 mg. Supporting daily doses: for children under 1 year old - 0.5-1 mg, at the age of 1-5 years - 1-3 mg, at the age of 5-12 years - 3-6 mg.
The dose is increased gradually. The daily dose is divided into 3-4 doses in equal parts. Maintenance therapy begins 2-3 weeks after the main one.
- Central nervous system (CNS): at the beginning of treatment - a feeling of fatigue, lethargy, severe inhibition, drowsiness, headaches, a state of torpor, dizziness; rarely - ataxia, confusion. When taking high doses, especially for a long time, paradoxical reactions are possible (including acute states of excitement), diplopia, anterograde amnesia, articulation disorders, nystagmus; rarely - muscle weakness, hyperergic reactions, depression. With long-term treatment of some forms of epilepsy, there is a possibility of an increase in the frequency of seizures;
- Dermatological reactions: changes in pigmentation, transient alopecia;
- Allergic reactions: skin rash, itching, urticaria; extremely rarely - anaphylactic shock;
- Respiratory system: in infants and young children - bronchial hypersecretion;
- Digestive system: rarely - nausea, heartburn, dry mouth, decreased appetite, vomiting, constipation or diarrhea, abnormal liver function, jaundice, increased activity of hepatic transaminases and alkaline phosphatase; in infants and young children - increased salivation;
- Endocrine system: dysmenorrhea, changes in libido, reversible incomplete premature puberty in children (premature sexual development);
- Cardiovascular system: lowering blood pressure, tachycardia;
- Urinary system: delay or incontinence, impaired renal function;
- Hematopoietic system: agranulocytosis, neutropenia, anemia, leukopenia, thrombocytopenia;
- Others: drug addiction, addiction; with a sharp decrease in dose or cessation of treatment - withdrawal syndrome.
With prolonged treatment with Clonazepam, children should be borne in mind the likelihood of its undesirable effects on mental and physical development, which may not manifest for many years.
Prolonged therapy leads to a weakening of the drug.
During treatment and for at least 3 days after its termination it is forbidden to consume alcoholic beverages.
Clonazepam affects the speed of psychomotor reactions, which should be considered for people who are engaged in potentially hazardous activities that require speed of reaction and increased attention.
Cancel the drug should be gradually reducing the dose.
When using clonazepam in combination, possible reactions should be considered:
- Sodium valproate - weakening of its action, provocation of convulsive seizures;
- Cimetidine - increased side effects from the central nervous system (however, it should be noted that the frequency of convulsive seizures was reduced in some patients with this combination);
- Lithium carbonate - the development of neurotoxicity;
- Muscle relaxants - enhancing their action;
- Phenytoin - an increase in its concentration in the blood plasma and the development of toxic reactions or a decrease in its concentration;
- Tiaprid - development of neuroleptic malignant syndrome;
- Caffeine - a decrease in the anxiolytic and sedative effects of clonazepam;
- Ethanol and drugs that have a depressant effect on the central nervous system (antidepressants, antipsychotics, anticonvulsants, barbiturates, narcotic analgesics) and means that reduce the tone of skeletal muscles - enhancing the action of clonazepam and the inhibitory effect on the central nervous system;
- Fenelzin - development of headache with localization in the occipital region;
- Lamotrigine, carbamazepine - reducing the concentration of clonazepam in the blood plasma;
- Desipramine - a decrease in its plasma concentration (sometimes 2 times) and an increase after discontinuation of clonazepam;
- Primidone - increasing its concentration in the blood;
- Toremifen - acceleration of its metabolism;
- Nicotine is a weakening effect of clonazepam.
Terms and conditions of storage
Store at a temperature up to 25 ºС in a dry, dark place inaccessible to children.
Shelf life - 3 years.