Individualized maintenance doses range: A MedGuide that discusses the risk of suicidal thoughts and behaviors associated with the use of anticonvulsant medications is available. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Lorazepam and Xanax are both benzodiazepines that provide a tranquilizing effect. Both drugs treat anxiety disorders, including panic attacks in adults. Cause if she does not sleep I do not sleep cause I take care of her Clonazepam Positive Review - Part 1
Always discuss possible side effects with a healthcare provider who knows your medical history. Clonazepam oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help avoid interactions, your doctor should manage all of your medications carefully. Taking clonazepam with certain other medications may cause more side effects.
Examples of these drugs include:. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking. The use of drinks that contain alcohol can increase your risk of sedative effects from clonazepam. You may have slowed reflexes, poor judgment, and sleepiness.
This can be dangerous. If you drink alcohol, talk to your doctor. If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call or go to the nearest emergency room. Taking it again could be fatal cause death. For people with depression: If you have worsening symptoms of depression or any suicidal thoughts thoughts of harming yourself , call your doctor right away. For people with acute narrow angle glaucoma: It can make your condition worse.
For people with liver disease: If you have liver problems, your body may not be able to clear this drug well. This can cause the drug to build up in your body. This puts you at a higher risk for side effects. Clonazepam is a category D pregnancy drug. That means two things:. This drug should be used only if the potential benefit justifies the potential risk to the fetus.
Call your doctor right away if you become pregnant while taking this drug. For women who are breastfeeding: Clonazepam passes into breast milk and causes side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication. The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly.
As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. This dosage information is for clonazepam oral tablet. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:. Your doctor may start you on a lowered dose or a different dosing schedule.
This can help keep levels of this drug from building up too much in your body. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. Clonazepam oral tablet is used for short-term treatment. If you stop taking it suddenly, you may have symptoms of withdrawal. These include irritability, trouble sleeping, and anxiety.
If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:. If your symptoms are severe, call or go to the nearest emergency room right away. What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once.
This could result in dangerous side effects. How to tell if the drug is working: You should have fewer panic attacks or seizures. A prescription for this medication is refillable. However, clonazepam is a schedule IV controlled substance. Therefore, your prescription for this drug may be refilled no more than five times. Also, you can only get refills for six months after the date your doctor wrote the original prescription.
Subgroup analyses did not indicate that there were any differences in treatment outcomes as a function of race or gender. Clonazepam is useful alone or as an adjunct in the treatment of the Lennox-Gastaut syndrome petit mal variant , akinetic and myoclonic seizures. In patients with absence seizures petit mal who have failed to respond to succinimides, clonazepam may be useful.
In some cases, dosage adjustment may reestablish efficacy. Clonazepam is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-V. Panic disorder DSM-V is characterized by recurrent unexpected panic attacks, i. The effectiveness of clonazepam in long-term use, that is, for more than 9 weeks, has not been systematically studied in controlled clinical trials.
Concomitant use of benzodiazepines, including clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone.
If a decision is made to prescribe clonazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation. Advise both patients and caregivers about the risks of respiratory depression and sedation when clonazepam is used with opioids. Since clonazepam produces CNS depression, patients receiving this drug should be cautioned against engaging in hazardous occupations requiring mental alertness, such as operating machinery or driving a motor vehicle.
Suicidal Behavior and Ideation: Antiepileptic drugs AEDs ,including Clonazepam, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of placebo-controlled clinical trials mono- and adjunctive therapy of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk adjusted Relative Risk 1.
In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behavior or ideation among 27, AED-treated patients was 0. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide. The increased risk of suicidal thoughts or behavior with AEDs was observed as early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed.
Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed. The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication.
The risk did not vary substantially by age years in the clinical trials analyzed. Table 1 shows absolute and relative risk by indication for all evaluated AEDs. The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications.
Anyone considering prescribing clonazepam or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.
Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm.
Behaviors of concern should be reported immediately to healthcare providers. Data from several sources raise concerns about the use of clonazepam during pregnancy. In three studies in which clonazepam was administered orally to pregnant rabbits at doses of 0. Recent reports suggest an association between the use of anticonvulsant drugs by women with epilepsy and an elevated incidence of birth defects in children born to these women.
Data are more extensive with respect to diphenylhydantoin and phenobarbital, but these are also the most commonly prescribed anticonvulsants; less systematic or anecdotal reports suggest a possible similar association with the use of all known anticonvulsant drugs. In children of women treated with drugs for epilepsy, reports suggesting an elevated incidence of birth defects cannot be regarded as adequate to prove a definite cause and effect relationship.
There are intrinsic methodologic problems in obtaining adequate data on drug teratogenicity in humans; the possibility also exists that other factors e. The great majority of mothers on anticonvulsant medication deliver normal infants. It is important to note that anticonvulsant drugs should not be discontinued in patients in whom the drug is administered to prevent seizures because of the strong possibility of precipitating status epilepticus with attendant hypoxia and threat to life.
In individual cases where the severity and frequency of the seizure disorder are such that the removal of medication does not pose a serious threat to the patient, discontinuation of the drug may be considered prior to and during pregnancy; however, it cannot be said with any confidence that even mild seizures do not pose some hazards to the developing embryo or fetus. An increased risk of congenital malformations associated with the use of benzodiazepine drugs has been suggested in several studies.
There may also be non-teratogenic risks associated with the use of benzodiazepines during pregnancy. There have been reports of neonatal flaccidity, respiratory and feeding difficulties, and hypothermia in children born to mothers who have been receiving benzodiazepines late in pregnancy. In addition, children born to mothers receiving benzodiazepines late in pregnancy may be at some risk of experiencing withdrawal symptoms during the postnatal period.
In general, the use of clonazepam in women of childbearing potential, and more specifically during known pregnancy, should be considered only when the clinical situation warrants the risk to the fetus. The specific considerations addressed above regarding the use of anticonvulsants for epilepsy in women of childbearing potential should be weighed in treating or counseling these women. Because of experience with other members of the benzodiazepine class, clonazepam is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester.
Because use of these drugs is rarely a matter of urgency in the treatment of panic disorder, their use during the first trimester should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
Patients should also be advised that if they become pregnant during therapy or intend to become pregnant, they should communicate with their physician about the desirability of discontinuing the drug. When used in patients in whom several different types of seizure disorders coexist, clonazepam may increase the incidence or precipitate the onset of generalized tonic-clonic seizures grand mal. This may require the addition of appropriate anticonvulsants or an increase in their dosages.
The concomitant use of valproic acid and clonazepam may produce absence status. Periodic blood counts and liver function tests are advisable during long-term therapy with clonazepam. The abrupt withdrawal of clonazepam, particularly in those patients on long-term, high-dose therapy, may precipitate status epilepticus. Therefore, when discontinuing clonazepam, gradual withdrawal is essential. While clonazepam is being gradually withdrawn, the simultaneous substitution of another anticonvulsant may be indicated.
Metabolites of clonazepam are excreted by the kidneys; to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function. Clonazepam may produce an increase in salivation. This should be considered before giving the drug to patients who have difficulty handling secretions. Clonazepam should be used with caution in patients with compromised respiratory function.
Clonazepam may have a porphyrogenic effect and should be used with care in patients with porphyria. A clonazepam Medication Guide must be given to the patient each time clonazepam is dispensed, as required by law. Patients should be instructed to take clonazepam only as prescribed. Physicians are advised to discuss the following issues with patients for whom they prescribe clonazepam:.
To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug. Because benzodiazepines have the potential to impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that clonazepam therapy does not affect them adversely.
Patients, their caregivers, and families should be counseled that AEDs, including clonazepam, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. This registry is collecting information about the safety of antiepileptic drugs during pregnancy.
Patients should be advised not to breastfeed an infant if they are taking clonazepam. Patients should be advised to inform their physicians if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions. Patients should be informed that clonazepam orally disintegrating tablets contain phenylalanine a component of aspartame. Each orally disintegrating tablet contains 0. The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration.
When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists. Limit dosage and duration of concomitant use of benzodiazepines and opioids, and follow patients closely for respiratory depression and sedation. Clonazepam does not appear to alter the pharmacokinetics of phenytoin, carbamazepine or phenobarbital.
The effect of clonazepam on the metabolism of other drugs has not been investigated. Literature reports suggest that ranitidine, an agent that decreases stomach acidity, does not greatly alter clonazepam pharmacokinetics. Fluoxetine does not affect the pharmacokinetics of clonazepam. Although clinical studies have not been performed, based on the involvement of the cytochrome P 3A family in clonazepam metabolism, inhibitors of this enzyme system, notably oral antifungal agents, should be used cautiously in patients receiving clonazepam.
The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs. The data currently available are not sufficient to determine the genotoxic potential of clonazepam.
To provide information regarding the effects of in utero exposure to clonazepam, physicians are advised to recommend that pregnant patients taking clonazepam enroll in the NAAED Pregnancy Registry. This can be done by calling the toll free number , and must be done by patients themselves. Information on this registry can also be found at the website http: The effect of clonazepam on labor and delivery in humans has not been specifically studied; however, perinatal complications have been reported in children born to mothers who have been receiving benzodiazepines late in pregnancy, including findings suggestive of either excess benzodiazepine exposure or of withdrawal phenomena see WARNINGS, Pregnancy Risks.
Safety and effectiveness in pediatric patients with panic disorder below the age of 18 have not been established. Clinical studies of clonazepam did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Sedating drugs may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of clonazepam and observed closely. The adverse experiences for clonazepam are provided separately for patients with seizure disorders and with panic disorder. The most frequently occurring side effects of clonazepam are referable to CNS depression. Hair loss, hirsutism, skin rash, ankle and facial edema.
Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, increased appetite, nausea, sore gums. Hepatomegaly, transient elevations of serum transaminases and alkaline phosphatase. Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain. Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis the behavior effects are more likely to occur in patients with a history of psychiatric disturbances.
The following paradoxical reactions have been observed: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages. Adverse events during exposure to clonazepam were obtained by spontaneous report and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories.
In the tables and tabulations that follow, CIGY dictionary terminology has been used to classify reported adverse events, except in certain cases in which redundant terms were collapsed into more meaningful terms, as noted below. The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation.
Table 3 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred during acute therapy of panic disorder from a pool of two 6- to 9-week trials. The prescriber should be aware that the figures in Table 3 cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials.