Clonazepam

May be taken with or without food.

Acute narrow-angle glaucoma, acute pulmonary insufficiency, severe respiratory insufficiency, sleep apnoea syndrome, myasthenia gravis. Patient in a coma, or with known alcohol or drug abuse. Severe (epilepsy/status epilepticus) or significant (panic disorder) hepatic impairment.

Patient with depression and/or suicide attempts; open-angle glaucoma, chronic pulmonary insufficiency, porphyria, compromised respiratory function (e.g. COPD), difficulty handling secretions, spinal or cerebellar ataxia, history of alcohol or drug dependence or abuse. Patient at increased risk of falls or whom a drop in blood pressure may result in cardiac or cerebral complications. Concomitant use with opioids. Avoid abrupt withdrawal. Renal and mild to moderate hepatic impairment. Debilitated patient. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause CNS depression, if affected, do not drive or operate machinery. Monitoring Parameters Monitor CBC, liver and renal function tests periodically with prolonged treatment; signs of suicidality (e.g. emergence or worsening of depression, suicidal thoughts, behavioural changes). Closely observe for signs and symptoms of sedation and respiratory depression (patients receiving concomitant opioids).

Significant: Suicidal thoughts or behaviour, anterograde amnesia, worsening of seizures (in patients with multiple seizure types), CNS depression, paradoxical reactions, including hyperactive or aggressive behaviour; sleep-related activities (e.g. sleep-driving, cooking or eating food, making phone calls while asleep); respiratory depression, salivary or bronchial hypersecretion (infants and children); may precipitate hepatic encephalopathy; drug tolerance, dependence, misuse and abuse; withdrawal reactions. Rarely, hypotension. Eye disorders: Blurred vision, nystagmus, diplopia. Gastrointestinal disorders: Constipation, abdominal pain, nausea. General disorders and administration site conditions: Fatigue, ataxia; thrombophlebitis (rapid IV inj/infusion). Immune system disorders: Allergic reactions. Injury, poisoning and procedural complications: Falls. Musculoskeletal and connective tissue disorders: Muscle weakness. Nervous system disorders: Drowsiness, dizziness, light-headedness, headache. Psychiatric disorders: Excitability, irritability, agitation, nervousness, hostility, anxiety, poor concentration, restlessness, confusion, disorientation, dysarthria, sleep disturbances, nightmares, vivid dreams. Skin and subcutaneous tissue disorders: Rarely, urticaria, pruritus, transient hair loss, pigmentation changes.

Additive CNS depressant effects with other anticonvulsants, TCAs, MAOIs, sedative and hypnotics, barbiturates, antihistamines, anxiolytics, antipsychotics and anaesthetics. May increase or decrease the serum levels of phenytoin. May rarely cause absence status epilepticus with valproic acid. CYP3A4 inhibitors (e.g. fluconazole, cimetidine) may impair the metabolism of clonazepam.

Anticonvulsants / Anxiolytics

N03AE01 - clonazepam ; Belongs to the class of benzodiazepine derivatives antiepileptic.