Metabolism of clonazepam may possibly be accelerated by rifampicin. Clonazepam may possibly antagonise effects of levodopa. There are enhanced hypotensive and sedative effects when clonazepam is given with alpha-blockers or with moxonidine. There is an enhanced hypotensive effect when clonazepam is given with ACE inhibitors, adrenergic neurone blockers, angiotensin-II receptor antagonists, betablockers, calcium channel blockers, clonidine, diazoxide, diuretics, hydralazine, methyldopa, minoxidil, nitrates or nitroprusside.
There is an increased sedative effect when clonazepam is given with alcohol, general anaesthetics, tricyclic and tricyclic-related antidepressants, antihistamine less so for non-sedating antihistamines and not usually for topically applied antihistamines , antipsychotics, baclofen, lofexidine, mirtazapine, nabilone, opioid analgesics, tizanidine.
Clonazepam should not be used during pregnancy unless clearly necessary. Administration of high doses in the last trimester of pregnancy or during labour can cause irregularities in the heart beat of the unborn child and hypothermia, hypotonia, mild respiratory depression and poor sucking in the neonate. Infants born to mothers who took benzodiazepines chronically during the later stages of pregnancy may have developed physical dependence and may be at some risk for developing withdrawal symptoms in the post-natal period.
Lactation Clonazepam passes into the maternal milk in small amounts. Therefore, clonazepam should not be used in mothers who breastfeed unless clearly necessary. Even when adequately controlled on clonazepam, increases in dosage or alteration in timings of dosage may modify patients reactions, depending on individual susceptibility. Clonazepam can slow reaction to such an extent that the ability to drive a vehicle or operate machinery is impaired.
The decision for allowing the patient to drive rests with their doctor and should be based on the patients response to treatment and the dosage involved. They tend to occur early in treatment and can be greatly reduced, if not avoided, by commencing with low dosages followed by progressive increases. Blood and the lymphatic system disorders Isolated cases of blood dyscrasias.
Immune system disorders Allergic reaction and a very few cases of anaphylaxis and angioedema. Endocrine disorders Isolated cases of reversible development of premature secondary sex characteristics in children incomplete precocious puberty have been reported.
Psychiatric disorders Anterograde amnesia risk increases at higher dosages. Amnestic effects may be associated with inappropriate behaviour. Depression, loss of libido, impotence. Use of benzodiazepines may lead to the development of physical and psychological dependence upon these products.
The risk of dependence increases with dose and duration of treatment and is particularly pronounced in predisposed patients with a history of alcoholism or drug abuse. Paradoxical effects such as aggressiveness, excitability, nervousness, hostility, anxiety, sleep disturbances, nightmares, vivid dreams, irritability, agitation, psychotic disorders and activation of new types of seizures may occur. If these occur, the benefit of continuing the drug should be weighed against the adverse effect.
It may be necessary to add another suitable drug to the regimen or to discontinue clonazepam therapy. With certain forms of epilepsy, an increase in the frequency of seizures during longterm treatment is possible.
Rarely, convulsions may be induced in patients with porphyria. Eye disorders Double vision and nystagmus are reversible disorders and occur particularly in longterm or high-dose treatment. Respiratory, thoracic and mediastinal disorders Rarely respiratory depression may occur with intravenous clonazepam, particularly if other depressant drugs have been administered.
This effect can usually be avoided by careful adjustment of the dose to individual requirements. In infants and small children, and particularly those with a degree of mental impairment, salivary or bronchial hypersecretion with drooling may occur.
Supervision of the airway may be required. Hepato-biliary disorders Isolated cases of abnormal liver function tests have been reported. Skin and subcutaneous tissue disorders Rarely: General disorders and administration site conditions Withdrawal: Once physical dependence has developed, abrupt termination of treatment will be accompanied by withdrawal symptoms.
During long-term treatment, withdrawal symptoms may develop, especially withdrawing from high doses or if the daily dose is reduced rapidly or abruptly discontinued.
In severe cases the following symptoms may occur: Since the risk of withdrawal symptoms is greater after abrupt discontinuation of treatment, discontinuation should be carried out by gradually reducing the daily dose. Patients have recovered from overdoses in excess of 60mg without special treatment. Severe somnolence with muscle hypotonia will be present. The symptoms of overdosage or intoxication vary greatly from person to person depending on age, bodyweight and individual response.
Benzodiazepines commonly cause drowsiness, ataxia, dysarthria and nystagmus. Coma, hypotension and respiratory depression occasionally occur but are seldom serious if these drugs are taken alone.
Coma usually lasts only a few hours but in elderly people it may be more protracted and cyclical. Benzodiazepine respiratory depressant effects are more serious in patients with severe chronic obstructive airways disease. Benzodiazepines potentiate the effects of other central nervous system depressants, including alcohol.
Maintain a clear airway and adequate ventilation if indicated. The benefit of gastric decontamination is uncertain. Consider activated charcoal 50g for an adult, g for a child in adults or children who have taken more than 0. Gastric lavage is unnecessary if these drugs have been taken alone. Patients who are asymptomatic at 4 hours are unlikely to develop symptoms.
Supportive measures as indicated by the patient's clinical state. Flumazenil Anexate , a benzodiazepine antagoinist is available but should rarely be required. It has a short half-life about an hour. Warning The use of flumazenil is not recommended in epileptic patients who have been receiving benzodiazepine treatment for a prolonged period.
Although flumazenil exerts a slight intrinsic anticonvulsant effect, its abrupt suppression of the protective effect of a benzodiazepine agonist can give rise to convulsions in epileptic patients. If excitation occurs, barbiturates should not be used.
N03AE01 Clonazepam exhibits pharmacological properties which are common to benzodiazepines and include anticonvulsive, sedative, muscle relaxing and anxiolytic effects.
Animal data and electroencephalographic investigations in man have shown that clonazepam rapidly suppresses many types of paroxysmal activity including the spike and wave discharge in absence seizures petit mal , slow spike wave, generalised spike wave, spikes with temporal or other locations as well as irregular spikes and waves. Generalised EEG abnormalities are more readily suppressed by clonazepam than are focal EEG abnormalities such as focal spikes.
Clonazepam has beneficial effects in generalised and focal epilepsies. Clonazepam may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby.
If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of clonazepam on the baby. Clonazepam can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.
Do not give this medicine to a child without medical advice. Clonazepam is not approved to treat panic disorder in anyone younger than 18 years old.
The sedative effects of clonazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking clonazepam.
How should I take clonazepam? Take clonazepam exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. Never share this medicine with another person, especially someone with a history of drug abuse or addiction.
Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law. Clonazepam should be used for only a short time. Do not take this medication for longer than 9 weeks without your doctor's advice.
Swallow the tablet whole, with a full glass of water. If you use this medicine long-term, you may need frequent medical tests. Do not stop using clonazepam suddenly or you could have unpleasant withdrawal symptoms, including a seizure convulsions. Ask your doctor how to safely stop using this medicine. Call your doctor if this medicine seems to stop working as well in treating your seizures or anxiety symptoms.
Seizures are often treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice. Store clonazepam at room temperature away from moisture, heat, and light.
Keep track of the amount of medicine used from each new bottle. Clonazepam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription. Dosage Information in more detail What happens if I miss a dose? Take the missed dose as soon as you remember.
© Copyright 2017 Clonazepam 2mg 30 tabletas / As this eMedTV Web page explains, the 2 mg clonazepam tablets are the highest strength available for the drug. This article lists the other strengths for clonazepam..