clonazepam KLONOPIN

Class: Benzodiazepine/​Nitro
FDA Indications: Panic Disorder, Seizure Disorders
Off-Label Use: Agitation/aggression, Akathisia, Alcohol Withdrawal, Catatonia, Insomnia, Bipolar Mania, Restless Leg Syndrome, Lewy Body Dementia
Prescribing
FDA Schedule IV
Forms: 0.25, 0.5, 1, 2mg tablet
Dose Range: 0.25-6 mg/day
Starting: 0.25 mg bid; ↑ in increments of 0.125 to 0.25 mg bid q3 days
Stopping: Taper by 0.25 mg q3 days, slower for difficult-to-taper patients

NAMI drug fact sheet

Precautions
Contraindications: Sleep apnea, significant hepatic impairment
Serious Side Effects: Overdose can result in hypotension, respiratory depression, and coma
Side Effects: sedation/somnolence, dizziness, confusion, disequilibrium, ataxia, lightheadedness, weakness/asthenia, decreased libido, dysarthria, constipation, increased appetite, weight gain
Pharmacodynamics
1° MOA: GABAAR PAM
2° MOA: May enhance serotonergic neurotransmission
Target: GABAA: α2, α3, γ2 (high); α1 (low to moderate)
Pharmacokinetics
t½: 34 (19-60)° TMAX: 1-4°
Absorption Rate: Rapid
Lipid Solubility: Low
Substrate of: 3A4; 2B4, 2E1
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
Misc
  • - moderate degree of sedation
  • - longer t½ makes it easier to taper
  • - better tolerability profile ie ↓ euphoria and abuse potential
Special Populations

Category D—↑ risk of oral cleft by 0.01%, use just before delivery associated with floppy infant syndrome, 3rd trimester use can cause withdrawal in newborns

RID 1.5-3%; ∅ AE's have been reported


Initiate with low doses and observe closely



2019 BEE℞S Recommendation: Avoid. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long- acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults. May be appropriate for seizure disorders, RBD, benzodiazepine withdrawal, EtOH withdrawal, severe GAD, and periprocedural anesthesia.

Metabolites may accumulate in patients with renal impairment

There are no dosage adjustments provided in the manufacturer's labeling

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Last updated March 25 2019 15:25:58. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.