Return to Common Drugs Index
clonazepam
Klonopin, Paxam‡, Rivotril†

Controlled Substance Schedule IV

Pregnancy Risk Category D

How supplied
Tablets:
0.5 mg, 1 mg, 2 mg
Drops:
2.5 mg/ml‡
Injection:
1 mg/ml‡

Action
Unknown. A benzodiazepine that probably acts by facilitating the effects of the inhibitory neurotransmitter gamma-aminobutyric acid.

Indications & dosage
Lennox-Gastaut syndrome, atypical absence seizures, akinetic and myoclonic seizures--

Adults:
initially, not to exceed 1.5 mg P.O. daily in three divided doses. May be increased by 0.5 to 1 mg q 3 days until seizures are controlled. If given in unequal doses, largest dose given h.s. Maximum recommended daily dose is 20 mg.
Children
up to age 10 or 30 kg (66 lb): initially, 0.01 to 0.03 mg/kg P.O. daily (not to exceed 0.05 mg/kg daily) in two or three divided doses. Increased by 0.25 to 0.5 mg q third day to maximum maintenance dose of 0.1 to 0.2 mg/kg daily, p.r.n.
Status epilepticus (where parenteral form is available)--

Adults:
1 mg by slow I.V. infusion.
Children:
0.5 mg by slow I.V. infusion.
Panic disorder--

Adults:
initially, 0.25 mg P.O. b.i.d.; increase to target dose of 1 mg/day after 3 days. Some patients may benefit from doses up to maximum of 4 mg/day. To achieve 4 mg/day, dosage increased in increments of 0.125 to 0.25 mg b.i.d. q 3 days as tolerated until panic disorder is controlled. Discontinue drug gradually with decrease of 0.125 mg b.i.d. q 3 days until drug is stopped.

Adverse reactions
CNS:
drowsiness, ataxia, behavioral disturbances (especially in children), slurred speech, tremor, confusion, agitation, depression.
CV:
palpitations.
EENT:
nystagmus, abnormal eye movements, sore gums.
GI:
constipation, gastritis, change in appetite, nausea, anorexia, diarrhea.
GU:
dysuria, enuresis, nocturia, urine retention.
Hematologic: leukopenia, thrombocytopenia,
eosinophilia.
Hepatic:
elevated liver function test results.
Respiratory: respiratory depression,
chest congestion, shortness of breath.
Skin:
rash.

Interactions
Drug-drug.
Carbamazepine, phenobarbital, phenytoin: lowered plasma clonazepam levels. Monitor closely.
CNS depressants:
increased CNS depression. Avoid concomitant use.
Drug-lifestyle.
Alcohol use: increased CNS depression. Avoid concomitant use.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to benzodiazepines and in those with significant hepatic disease or acute angle-closure glaucoma.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

Return to Common Drugs Index