Clonazepam
Clonazepam: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Use in childhood
- 10. Use in the elderly
- 11. Drug interactions
- 12. Analogs
- 13. Terms and conditions of storage
- 14. Terms of dispensing from pharmacies
- 15. Reviews
- 16. Price in pharmacies
Latin name: Clonazepam
ATX code: N03AE01
Active ingredient: clonazepam (clonazepam)
Producer: REMEDICA (Cyprus), Tarchomin Pharmaceutical Works Polfa (Poland)
Description and photo update: 2019-13-08
Clonazepam is a drug with sedative, muscle relaxant, anxiolytic, anticonvulsant and antiepileptic effects.
Release form and composition
Clonazepam is produced in the form of tablets (30 pcs. In blisters, 1 blister in a cardboard box; 10 pcs. In blisters, 3 packages in a cardboard box).
The composition of 1 tablet contains the active substance: clonazepam - 0.5 or 2 mg.
Pharmacological properties
Pharmacodynamics
Clonazepam is an antiepileptic drug belonging to the group of benzodiazepine derivatives. It enhances the inhibitory effect of gamma-aminobutyric acid on the transmission of nerve impulses. Also, this compound stimulates benzodiazepine receptors localized in the allosteric center of postsynaptic receptors sensitive to gamma-aminobutyric acid (GABA) and located in the interneurons of the lateral horns of the spinal cord and the ascending activating reticular formation of the brainstem.
Clonazepam slows down postsynaptic spinal reflexes and reduces the excitability of the subcortical structures of the brain (hypothalamus, thalamus, limbic system).
The anxiolytic effect of the drug is explained by the effect on the amygdala complex of the limbic system. It is expressed in the weakening of feelings of fear, anxiety, anxiety, and a decrease in emotional stress.
Sedation is associated with the effect of clonazepam on the nonspecific nuclei of the thalamus and the reticular formation of the brain stem. It is manifested by a decrease in the severity of symptoms of a neurotic nature (anxiety, anxiety).
The anticonvulsant effect occurs due to the activation of presynaptic inhibition. This prevents the spread of epileptogenic activity, which occurs in epileptogenic foci located in the limbic structures, thalamus and cortex. However, the excited state of the focus is not eliminated.
It has been proven that in humans, clonazepam quickly minimizes paroxysmal activity of various types, including “adhesions” of temporal and other localization, generalized and slow “spike-wave” complexes, “spike-wave” complexes accompanying absences (petit mal), and waves and "spikes" of an irregular nature.
Changes in the electroencephalogram related to the generalized type are suppressed by the drug better than those related to the focal type. In this regard, the positive effect of the use of clonazepam is noted in both generalized and focal forms of epilepsy.
The reason for the central muscle relaxant action is the inhibition of polysynaptic spinal afferent inhibitory pathways (this applies to monosynaptic ones to a lesser extent). Presumably, there is also a direct suppression of muscle function and motor nerve function.
Pharmacokinetics
After oral administration, clonazepam is absorbed from the gastrointestinal tract by 90%. Its maximum level in blood plasma is reached within 1–3 hours after ingestion. The substance binds to plasma proteins by about 5%. It also crosses the placental and blood-brain barriers and is determined in breast milk.
Clonazepam is metabolized in the liver to metabolites that have practically no pharmacological activity. The half-life is approximately 20-60 hours. The drug is excreted in the form of metabolites through the kidneys (50–70%) and gastrointestinal tract (10–30%). Approximately 0.5% of the dose taken is excreted in the urine unchanged.
Indications for use
- Epilepsy (myoclonic, akinetic; temporal, generalized submaximal and focal seizures) in adults and children;
- Phobias, paroxysmal fear syndromes (in patients over 18 years old);
- Psychomotor agitation in reactive psychoses;
- Manic phase of cyclothymia.
Contraindications
- Disturbances of consciousness, breathing (central genesis);
- Respiratory failure;
- Myasthenia gravis;
- Glaucoma;
- Severe functional disorders of the liver;
- Age up to 18 years (with paroxysmal fear);
- Hypersensitivity to drug components.
Pregnant women can use Clonazepam only for absolute indications. Breastfeeding mothers should stop breastfeeding.
The drug should be used with caution in elderly patients (over 65 years old), as well as in patients with chronic diseases of the respiratory system and functional disorders of the liver and kidneys.
Instructions for the use of Clonazepam: method and dosage
Clonazepam is taken orally.
For epilepsy, the following dosing regimens are commonly used:
- Adults: the initial dose is 0.5 mg 3 times a day, then the dose is gradually increased (every 3 days by 0.5-1 mg); maintenance daily dose - 4-8 mg (3-4 divided doses); the maximum daily dose is 20 mg;
- Children: initial dose - 0.5 mg 2 times a day, then gradually increase the dose (every 3 days by 0.5 mg); maintenance daily dose - 1-3 mg (children under 5 years old) or 3-6 mg (children 5-12 years old); the maximum daily dose is 0.2 mg / kg.
In the treatment of paroxysmal fear syndrome, adults are usually prescribed 1 mg of Clonazepam per day (maximum 4 mg per day).
Side effects
During the use of Clonazepam, the following side effects may occur: feeling of fatigue, drowsiness, dizziness, discoordination, ataxia, weakness, visual disturbances, speech and memory impairments, nervousness, emotional lability, weakening of the ability to absorb knowledge, decreased libido, depression, disorientation, hypersalivation, signs of catarrhal inflammation of the upper respiratory tract, constipation, decreased appetite, abdominal pain, muscle pain, frequent urination, menstrual irregularities, erythro-, thrombo- and leukocytopenia, increased blood concentration of alkaline phosphatase and transaminases, skin allergic manifestations, paradoxical reactions, including insomnia and agitation (require discontinuation of therapy).
Overdose
An overdose of Clonazepam can be suspected by the following symptoms: decreased blood pressure, bradycardia, severe weakness, drowsiness, confusion, weakening of reflexes, paradoxical agitation, tremor, nystagmus, dysarthria, ataxia, shortness of breath or shortness of breath, depression of the respiratory center and cardiac activity, comatose …
As a treatment, gastric lavage and the intake of a sorbent - activated carbon - are prescribed. Symptomatic therapy is also recommended in order to maintain respiratory function and stabilize blood pressure. It has been proven that hemodialysis is ineffective.
special instructions
Long-term use of Clonazepam can lead to a weakening of its effect.
During therapy and for another 3 days after its end, alcohol should not be consumed.
With the cancellation of treatment, the dose is gradually reduced, since an abrupt discontinuation of the drug (especially after a long course) can lead to the development of psychophysical dependence and the emergence of withdrawal symptoms.
It is impossible to drive vehicles and perform maintenance of moving mechanical devices during therapy.
Pediatric use
With long-term treatment of children with clonazepam, it is necessary to bear in mind the risk of side effects on mental and physical development, which can have long-term consequences and appear many years after the start of therapy.
Use in the elderly
According to the instructions, Clonazepam is used with caution in elderly patients, since the rate of elimination of the drug may slow down in them, as well as a decrease in tolerance is observed, especially with diagnosed cardiopulmonary insufficiency.
Drug interactions
The effect of Clonazepam is enhanced by antipsychotics, barbiturates, antidepressants, anticonvulsants, alcohol, narcotic analgesics, drugs that reduce skeletal muscle tone.
The weakening of the action of the drug is observed with simultaneous use with nicotine.
Simultaneous use with alcohol can lead to the development of paradoxical reactions, manifested as aggressive behavior or psychomotor agitation, possibly a state of pathological intoxication.
Analogs
Clonazepam analogs are: Rivotril, Clonazepam IC.
Terms and conditions of storage
Store in a dark, dry place out of reach of children at temperatures up to 25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews of Clonazepam
According to reviews, Clonazepam is effective for epilepsy, muscle hypertonia, West syndrome, and a tendency to seizures. However, some patients note that the treatment is accompanied by drowsiness, addiction and other side effects.
The price of Clonazepam in pharmacies
On average, the price for Clonazepam with a dosage of 2 mg is 128-152 rubles (the package includes 30 tablets).
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
