Clonazepam

Clonazepam

Brand Name: Apo-Clonazepam (CAN), Clonapam (CAN), Gen-Clonazepam (CAN), Klonopin, Rivotril (CAN)

Pregnancy Category D, C-IV controlled substance

Drug classes: Benzodiazepine, Antiepileptic agent

 

Therapeutic actions

Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter.

 

Indications

· Used alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures; may be useful in patients with absence (petit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug, often within 3 mo of therapy (may respond to dosage adjustment)

· Unlabeled uses: treatment of panic attacks, periodic leg movements during sleep, hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, adjunct treatment of schizophrenia, neuralgias

 

Contraindications

· Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome), lactation (infants become lethargic and lose weight).

 

Adverse effects

Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema, urticaria, pruritus, rash, dermatitis, Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion, Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction, encoporesis

Drug Interactions:

· Increased CNS depression with alcohol

· Increased effect with cimetidine, disulfiram, omeprazole, oral contraceptives

· Decreased effect with theophylline

· Risk of increased digoxin levels and toxicity; monitor patient carefully

 

 

Nursing considerations

CLINICAL ALERT!

Name confusion has been reported between Klonopin (clonazepam) and clonidine; use caution.

 

· Monitor addiction-prone patients carefully because of their predisposition to habituation and drug dependence.

· Monitor liver function, blood counts periodically in patients on long-term therapy.

· Taper dosage gradually after long-term therapy, especially in epileptic patients; substitute another antiepileptic drug.

· Monitor patient for therapeutic drug levels: 20–80 ng/mL.

· Arrange for patient to wear medical alert ID indicating epilepsy and drug therapy.