Clonazepam

When ATH:
N03AE01

Characteristic.

Benzodiazepines. Light yellow crystalline powder. Practically insoluble in water, slightly soluble in alcohol and chloroform, better in acetone.

Pharmacological action.
Anticonvulsant, anxiolytic, sedation, miorelaksiruyuschee, central.

Application.

Absences (usually, not the drug of choice due to the side effects and possible addiction); atypical absences, atonic, and myoclonic seizures (the original or additional therapy); increased muscle tone, sleep disorders, panic disorder; status epilepticus (parenteral administration).

Contraindications.

Hypersensitivity, incl. other benzodiazepines, zakrыtougolynaya glaucoma, myasthenia, depression of the respiratory center, severe respiratory failure, severe liver and / or kidney failure, lactation, Age to 18 years (for panic disorder).

Restrictions apply.

Otkrыtougolynaya glaucoma (against the background of adequate therapy), chronic respiratory failure, Saint Martin's evil, drug dependence, incl history, liver dysfunction and / or kidney, pregnancy.

Pregnancy and breast-feeding.

Use in pregnancy and childbirth are allowed only on strict conditions, if the effect of therapy outweighs the potential risk to the fetus.

Women, taking clonazepam, its cancellation before or during pregnancy is possible only in cases, where if untreated seizures are weak and rare, and if the probability of status epilepticus and withdrawal symptoms is estimated as low. There are reports, that taking anticonvulsants during pregnancy in women, epileptics, It increases the incidence of birth defects in their children.

Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)

At the time of treatment should stop breastfeeding.

Side effects.

From the nervous system and sensory organs: oppression CNS is drowsiness (about 50%) and Ataxia (about 30%), in some cases decreases with time; behavioral disturbances (25%), most likely in patients with a history of mental disorders; visual impairment (incl. blurred vision, nistagmo, diplopia), abnormal eye movement, afonija, horeeformnye twitching, dysarthria, disdiadoxokinez, headache, gemiparez, muscular weakness, tremor, dizziness, slackness, fatigue, disorientation, reaction speed and concentration; confusion, depression, amnesia, hallucinations, vapors, insomnia, psychosis, suicide attempts, paradoxical reactions (severe agitation, irritability, nervousness, violent behavior, alarm, sleep disorders, nightmares and others.).

Cardio-vascular system and blood (hematopoiesis, hemostasis): heartbeat, anemia, leukopenia, thrombocytopenia, eozinofilija.

From the respiratory system: rhinorrhea, ʙronxoreja, respiratory depression (especially when on / in, in patients with concomitant diseases of the respiratory system, or while taking other medicines, respiratory depression).

From the digestive tract: violation of salivation (hypersalivation or dry mouth), sore gums, Anorexia / increased appetite, nausea, diarrhea / constipation, encopresis, gastritis, gepatomegaliya.

For the skin: transient hair loss, girsutizm.

Allergic reactions: skin rash, swelling of the ankles and face.

Other: fever, myalgia, increase or decrease in body weight, transient increases in ALT and AST levels, dehydration, lymphadenopathy, dizurija, enuresis, nocturia, urinary retention, changes in libido.

There may be addictive, drug dependence, withdrawal symptoms and aftereffects (see. "Safety Precautions").

Cooperation.

The inhibitory effect on the CNS increase alcohol, narcotic analgesics, hypnotics (incl. barbiturates), others. anxiolytics and anticonvulsants, neuroleptics (incl. fenotiazinы, thioxanthenes and butyrophenones), MAO inhibitors, tricyclic antidepressants. Phenytoin, Carbamazepine, phenobarbital accelerate the metabolism of clonazepam, reduce its level in the blood 30% and weaken the action.

Overdose.

Symptoms: CNS depression of varying severity (from drowsiness to coma): severe drowsiness, prolonged confusion, oppression reflexes, coma; possible respiratory depression.

Treatment: induction of vomiting and the appointment of activated carbon (If the patient is conscious), Gastric lavage through a tube (If the patient is unconscious), simptomaticheskaya therapy, monitoring vital functions (breathing, pulse, FROM), in / in a liquid (to enhance diuresis), if necessary - IVL. As a specific antidote may use benzodiazepine receptor antagonist flumazenil (in hospital), however, flumazenil is not indicated for use in patients with epilepsy (the probability of provocations seizures).

Dosing and Administration.

Inside, I /. The mode set individually depending on the evidence, the disease, portability, etc.. Treatment should start with the lowest effective dose. In epilepsy inside, initial dose for adults is 1 mg / day (older patients — 0,5 mg / day), usually overnight for 4 days, then gradually increase the dose within 2-4 weeks to a supporting individual is strictly (in the range 2-6 mg/day), frequency reception is 3 once a day, the maximum dose - 20 mg / day.

Patients in elderly, as well as in patients with impaired liver and kidney treatment should start with lower doses.

For children, the dose and duration of treatment picked individually, depending on the age and weight of the child.

Panic disorder (adults only, after 18 years): 1 mg / day (a maximum of 4 mg / day).

For relief of status epilepticus: in / slow, in children under 0,5 mg, adults — 1 mg; if necessary - re-; the maximum daily dose for the on/in the introduction is 13 mg.

Precautions.

Start the application, or abrupt withdrawal of clonazepam in patients with epilepsy or a history of seizures may accelerate the development of seizures or status epilepticus.

Several studies have shown, that approximately 30% patients, treated with anticonvulsant therapy for three months, there was a reduction of anticonvulsant activity PM, in some cases the dose adjustment allow this activity to recover.

The risk of drug dependence increases with the use of high doses and with increasing duration of administration, as well as in patients with drug and alcohol addiction in history. If necessary, discontinuation of treatment with clonazepam repeal should be gradual, by reducing the dose, to reduce the risk of withdrawal. It is necessary to co-administration of other antiepileptic drugs.

When abrupt cancellation after long-term use or high doses occurs withdrawal, characterized by psychomotor agitation, fear, vegetative disorders, insomnia, in severe cases, mental disorders.

In the treatment and counseling of women with epilepsy, wanting to have a baby, following should be considered: should not discontinue therapy with anticonvulsants, if the PM is used to prevent seizures, tk. There is a high probability of status epilepticus with attendant hypoxia and risk to life. In some cases,, when the severity and frequency of seizures is, suggesting that, that the abolition of therapy did not lead to a serious threat to life, You can cancel the treatment before and during pregnancy. It should be taken into account, even mid-denominated seizures can harm the embryo / fetus.

Prolonged use of clonazepam in pediatric patients should be evaluated the risks and benefits of possible side adverse effects on physical and mental development of the child, incl. delayed (It may not appear for several years,).

To apply caution in surgical and hospital patients, tk. Clonazepam can suppress the cough reflex.

During treatment with clonazepam unacceptable consumption of alcoholic beverages. To apply caution in conjunction with drugs, cause CNS depression. At simultaneous reception of funds, CNS depressants, or alcohol probability of serious adverse reactions increases.

In the event of paradoxical reactions clonazepam should be abolished.

Prolonged use should be periodically monitored picture peripheral blood and liver function.

During treatment with clonazepam and for 3 days after the end should not drive vehicles, and perform the work, requiring quickness of psychomotor reactions.