Drug Facts

Type of Drug:

Benzodiazepine. Anticonvulsant; drug used to treat epilepsy (seizures) and panic disorder.

How the Drug Works:

The actual mechanism of clonazepam’s action is unknown. However, it is believed that clonazepam prevents or reduces the number of seizures and controls panic attacks by acting on the central nervous system to control the activity of nerve impulses.

Uses:

To control Lennox-Gastaut syndrome (petit mal variant), akinetic, and myoclonic seizures either alone or in combination with other anticonvulsant drugs.

To treat absence (petit mal) seizures when succinimides have failed.

To treat panic disorder with or without agoraphobia (fear of crowds, public places, open areas).

Precatuions:

Multiple seizure type: When used in patients in whom several different types of seizure disorders coexist, c10nazepam may increase the frequency or precipitate the onset of generalized tonic-clonic (grand mal) seizures. This may require the addition of other anticonvulsant’s or an increase in dosage.

Chronic respiratory disease: Clonazepam may produce respiratory depression and an increase in salivation. In some patients, increased salivation can cause difficulty breathing. Because of these possibilities, use c10nazepam with caution in patients with chronic respiratory disease.

Withdrawal syndrome: Withdrawal symptoms (eg, convulsions, psychosis, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuation of c1onazepam. Severity is related to the degree of dependence and length of time used. The more severe withdrawal symptoms occurred in patients who received excessive doses over an extended period of time. After extended therapy, avoid abrupt discontinuation and follow a gradual dos­age tapering schedule.

Drug dependence: Addiction prone individuals (eg, alcoholics, drug addicts) must be closely supervised during clonazepam therapy. Dependence has occurred in such patients.

Pregnancy: Reports suggest an association between use of anticonvulsant drugs by women with epilepsy and an increased number of birth defects in children born to these women. Other factors (eg, genetics or the epileptic condition) may also contribute to the higher incidence of birth defects. Most mothers receiving anticonvulsant medication deliver normal infants. Do not discontinue anticonvulsant drugs used to prevent major seizures. This could result in the occurrence of seizures, oxygen deficiency in body tissues, and an increased risk to both the mother and the unborn child. In cases where seizures do not pose a serious threat, your doctor may recommend discontinuation of anticonvulsants prior to and during pregnancy. It is not known whether even minor seizures constitute some risk to the developing embryo or fetus. In addition, children born to mothers taking benzodiazepines late in pregnancy may exhibit side effects (eg, flaccid muscles, breathing or feeding difficulties) or withdrawal symptoms. Use this medicine during pregnancy only when benefits to the mother outweigh risks to the fetus.

Breastfeeding: Do not breastfeed while receiving clonazepam.

Children: Children being treated for seizure disorder may be more sensitive to the effects of this drug. Consult your doctor. Safety and effectiveness for use in children younger than 18 years of age with panic disorder have not been established.

Lab tests: Lab Testmay be required during treatment with c1onazepam. Tests may include blood counts and liver function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over the counter or prescription medications or dietary supplements with clonazepam. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with c1onazepam:

• Alcohol antidepressants (eg, fluvoxamine)
• Cimetidine (eg, tagamet)
• Contraceptives, oral (eg, orthonovum)
• Rifamycins (eg, rifampin)
• Valproic acid (eg, depakene)

Consider all drug interactions reported for benzodiazepines, in the Antianxiety Agents-Benzodiazepines monograph in this chapter when using this drug.

Side Effects:

Every drug is capable .of producing side effects. Many clonazepam users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors, including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Constipation; diarrhea; nausea; appetite changes.

Nervous System: Drowsiness; incoordination; behavior problems; headache; confusion; depression; memory loss; hysteria; bizarre behavior; mood changes; behavior changes; sleeplessness; tremor; dizziness; vertigo (feeling of whirling motion); partial paralysis; reduced intellectual ability; suicidal thoughts; nightmares; abnormal involuntary body movements; coma; hallUCinations.

Respiratory System: Difficult breathing; chest congestion; “runny” nose; coughing; sore throat.

Skin: Rash; excessive growth or loss of hair.

Eyes or Ocular: Blurred vision; double vision; “glassy-eyed” appearance; unusual eye movements.

Other: Fever; fatigue; loss of voice; increased salivation or dry mouth; coated tongue; changes in urination; fluid retention; difficulty speaking; sore gums; swollen lymph nodes; weight changes; increased or decreased sex drive; incontinence of urine or feces; muscle pain or weakness; dehydration; menstruation problems; sexual problems; general deterioration; pounding in the chest; slurred speech.

Guidelines for Use:

• Dosage will be individualized.
• Do not discontinue use or change the dose without first checking with your doctor. If you stop taking this drug suddenly, the frequency of your seizures could increase or you could experience withdrawal symptoms.
• Take with food if stomach upset occurs.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If several doses are missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist. Use exactly as prescribed.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding.
• May cause drowsiness, dizziness, or blurred vision. Use caution when driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Using this drug with alcohol or other central nervous system depressants (eg, pain relievers, sedatives) may cause added drowsiness.
• If the drug does not seem to be working as well after taking it for a few weeks, check with your doctor. A dosage adjustment may be needed.
• Carry Medic Alert identification indicating that you are using this drug and have epilepsy.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59° to 86°F).

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