Clonazepam is classified as a benzodiazepine. These are compounds used in neurology and psychiatry to treat sleep disorders, anxiety attacks, and epileptic states. Clonazepam belongs to the group of long-acting benzodiazepines. Its half-life in the body ranges from 20 to 40 hours. Clonazepam is considered to be more effective than diazepam, and requires a smaller dosage to obtain a therapeutic effect. It also has fewer side effects.

How clonazepam works

Clonazepam enhances the inhibitory effect of GABAergic neurons in the central nervous system. As a result of its action, the activity of other groups of neurons is reduced, e.g.

  • noradrenergic,
  • cholinergic,
  • dopaminergic
  • and serotonergic.

Benzodiazepines are considered safer than barbiturates because their inhibitory effects on neurons are limited to the amount of the messenger naturally present in the body. When the neurotransmitter is depleted, the inhibitory effect will also end.

Clonazepam has an effect:

  • anticonvulsants,
  • anxiolytic,
  • calming,
  • sleeping pills,
  • and also muscle-relaxing, i.e. reducing the tension of skeletal muscles.

After administration of clonazepam, the patient's seizure threshold increases, which reduces the incidence of generalized and focal seizures.

Indications for the use of clonazepam

According to the MSDS, clonazepam is indicated by injection as an epileptic drug to stop an attack. According to statistics, an epilepsy attack is 60 percent caused by the irregular use of antiepileptic drugs. It is a life-threatening condition. Paramedics can inject clonazepam in case of status epilepticus.

The indication for the use of clonazepam tablets is epilepsy in adults and children of a generalized nature, including:

  • akinetic seizures,
  • myoclonic seizures,
  • tonic-clonic seizures,
  • absences
  • and partial seizures, the so-called focal lengths.

However, chronic administration of clonazepam as an anticonvulsant drug is rare today because of long-term administration of this substancecauses the development of tolerance in the patient.

Sometimes the doctor decides to include clonazepam in the therapy when the patient suffers from drug-resistant epilepsy and other therapeutics are no longer effective. In such a situation, clonazepam is mentioned in the indications as a third-line drug.

Clonazepam may also be administered during an increased seizure frequency and when modifying existing AED therapy, especially when changes to treatment are implemented too quickly and may increase seizure frequency.

This drug is also used during:

  • behavioral disorders in the REN phase,
  • acute movement disorders,
  • severe panic attack,
  • mania,
  • states of high agitation in the patient
  • and when the patient shows suicidal thoughts.

Clonazepam is unlikely to be recommended for the treatment of insomnia as it is one of the strong long-acting benzodiazepines. The patient has a problem with safely discontinuing this medication. A situation in which a psychiatrist decides to administer clonazepam is severe insomnia in the patient.

Read more: Seizures: types

Clonazepam dosage

The doctor or paramedic decides about the dosage in case of injection. This decision is dictated by the patient's clinical condition and age.

Since parenteral administration of benzodiazepines, be it by injection or infusion, is dangerous due to the risk of respiratory depression, a medical professional will administer the drug slowly and carefully while monitoring the patient's vital functions.

The dosage of tablets in the treatment of patients with epilepsy also depends on the doctor and is selected individually for each patient.

It is generally accepted thatfor adults, the initial dose should not exceed 1.5 mg / day.The drug is administered in 3 divided doses with equal intervals of time. The amount of the drug can be increased gradually from 0.5 mg to 1 mg every 3 days. The maintenance dose for adult patients is 4 to 8 mg.

Please note thatthe maximum daily dose is 20 mgand should not be exceeded unless otherwise prescribed by your doctor in an exceptional situation.

In children from 1 to 5 years of age, the starting dose is 0.25 mg daily . The dose is then gradually increased to 1-2 mg daily. In older children, the starting dose is 0.5 mg daily and the maintenance dose is 2-4 mg daily.

Remember that the daily dose should be divided into 3-4 parts.

In elderly patients the dose should be reducedinitial and maintenance treatment, as this group of patients is particularly sensitive to drugs affecting the central nervous system.

Important information for the patient and the doctor is the situation in which the treatment with clonazepam does not bring any results. Then the drug should be discontinued and a different course of treatment should be chosen.

To avoid the occurrence of tolerance and to reduce the risk of withdrawal symptoms, the patient should be given the lowest effective dose.

Contraindications to the use of clonazepam

Do not give clonazepam if:

  • the patient suffers from hypersensitivity to benzodiazepines or other excipients present in the drug,
  • when the patient suffers from acute pulmonary insufficiency,
  • when the patient suffers from severe respiratory failure or severe liver failure,
  • when the patient suffers from sleep apnea,
  • if you suffer from myasthenia gravis,
  • in case of injection of clonazepam and the patient is an infant or premature baby, it may lead to irreversible changes. Responsible for such a reaction of the little patient is not the clonazepam itself, but the benzyl alcohol, which is contained in the formula of the injectable drug,
  • patients with alcohol poisoning.

Precautions and drug interactions

Benzodiazepines are considered safe as long as they are taken according to the doctor's recommendations and treatment with them is short-term. In the case of prolonged therapy, the patient may experience more serious side effects than the classic ones, such as headache or drowsiness.

Additionally, the patient is exposed to the development of addiction to this substance. It is worth noting that as the duration of therapy is extended, the anticonvulsant and sedative effects are smaller, so the drug is less effective (the so-called tolerance) and its doses should be increased. Doing so additionally increases the risk of side effects.

Withdrawal syndrome may occur in patients taking the drug chronically or in high doses, after abrupt discontinuation, characterized by:

  • increase in muscle tone,
  • decrease in the seizure threshold,
  • anxiety,
  • anxious,
  • insomnia.

Therefore, this medication should be discontinued gradually.

If you are taking clonazepam in high doses, you may develop anterograde amnesia. This condition appears several hours after taking the drug.

Some patients experience the so-called paradoxical drug reactions that manifest themselves as:

  • restlessness,
  • arousal,
  • aggression,
  • psychosis
  • or hallucinations.

In elderly patients, clonazepam has a greater chance of accumulating in the body, as a result of which there is increased sleepiness and reduced coordination in this group of patients. An older patient may fall as a result of this, so it is important that those close to him keep this in mind.

Clonazepam should be used with caution in patients with:

  • glaucoma,
  • chronic lung failure,
  • hepatic impairment
  • or impaired kidney function.

In infants and children, clonazepam may cause an excessive production of saliva and airway secretions. It is important to control the patency of the airways in these patients.

Do not drink alcohol while taking clonazepam or even after taking it only once. Alcohol in this case may reduce the effectiveness of the drug and cause the patient to become epileptic. You should wait at least 3 days after taking clonazepam if you plan to drink alcohol.

It should be remembered that the effect of clonazepam is enhanced by other drugs depressing the nervous system, that is:

  • older generation antihistamines,
  • opioid drugs,
  • other anticonvulsants,
  • antipsychotics
  • and alcohol.

By combining these drugs, the side effects of clonazepam may worsen, for example :

  • sedation,
  • excessive sleepiness,
  • deterioration of psychomotor performance.

Clonazepam should not be used in pregnant or lactating women without the knowledge and permission of a doctor.

Side effects of clonazepam

The most common side effects include:

  • sleepiness,
  • dizziness,
  • deterioration of psychomotor performance,
  • memory disorders less frequently,
  • visual disturbance
  • Do headaches.

The following may occur as a side effect:

  • bradycardia,
  • chest pain,
  • slight decrease in blood pressure,
  • nausea,
  • stomach discomfort,
  • fainting,
  • menstrual disorders,
  • urinary retention
  • or urinary incontinence.

In rare cases, respiratory depression may develop. Most often these are cases of administering a large dose of the drug intravenously over a short period of time. The risk of such a reaction increases if the patient additionally takes other medications that depress the respiratory center.

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