The drug 'Clonazepam' - instructions for use, description and reviews. Detailed instructions for the use of clonazepam

Formula: C15H10ClN3O3, chemical name: 5-(2-Chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one.
Pharmacological group: neurotropic drugs / antiepileptic drugs / benzodiazepine derivative.
Pharmachologic effect: anticonvulsant, sedative, anxiolytic, muscle relaxant, central.

Pharmacological properties

Clonazepam interacts in the postsynaptic GABA-receptor complex of the limbic system of the brain, hypothalamus, intercalary neurons of the lateral horns of the spinal cord, the ascending activating reticular formation of the brain stem with specific benzodiazepine receptors. Clonazepam increases the sensitivity of GABA receptors to its mediator, which leads to an increase in the frequency of opening channels for incoming currents of chloride ions in the cytoplasmic membrane of neurons. These processes lead to an increase in the inhibitory effect of GABA and a slowdown in interneuronal transmission in various parts of the central nervous system. Clinically, this is manifested by a strong and prolonged anticonvulsant effect.
Clonazepam also has a sedative (this effect is especially pronounced at the beginning of therapy), muscle relaxant, antiphobic and moderate hypnotic effects.
Clonazepam reduces the frequency of peak-wave complexes, which are detected on the EEG during absences (petit mal), as well as the amplitude, distribution, frequency of impulses during small motor seizures.
There are no studies on the possible carcinogenicity of clonazepam. Also, the data that are currently available do not allow to determine the possible genotoxicity of the drug. There are methodological problems that do not allow adequate data on the teratogenicity of clonazepam when used in humans, as some factors (eg, the epileptic condition itself or genetic defects) may be more significant than drug treatment in the development of various congenital malformations.
When administered orally, clonazepam is completely and rapidly absorbed from the gastrointestinal tract. Absolute bioavailability is approximately 90%. After a single oral dose, the maximum concentration is usually reached within 1-2 hours, but in some patients this time may increase up to 4-8 hours. It is approximately 85% bound to plasma proteins. Therapeutic plasma concentrations are about 0.02–0.08 µg/ml. Clonazepam passes into breast milk, through the placenta and the blood-brain barrier. In the liver, the drug is metabolized (it is possible that with the participation of cytochrome P450, including CYP3A) and pharmacologically inactive metabolites are formed. The half-life is 18-50 hours. It is mainly excreted by the kidneys (less than 2% unchanged), as well as with feces.

Indications

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

Clonazepam route and dosage

Clonazepam is used intravenously, by mouth (regardless of food intake). The dosage regimen should be set individually depending on the course of the disease, indications, tolerability and other factors. Therapy should be started with the lowest effective dose.
In epilepsy, clonazepam is taken orally, for adults, the initial dose is 1 mg / day (elderly patients - 0.5 mg / day), usually at night for 4 days, then the dose is gradually increased over 2-4 weeks to a maintenance dose - it is strictly individual ( usually in the range of 2–6 mg/day), the frequency of administration is 3 times a day, the maximum dose of clonazepam is 20 mg/day. Patients of senile and elderly age, as well as in violation of the kidneys or liver, therapy should be started with lower doses.
For children, the dose and duration of the course of therapy are selected strictly individually, depending on the body weight and age of the child. For panic disorders (only after 18 years): 1 mg / day (up to a maximum of 4 mg / day).
To relieve status epilepticus: slowly intravenously, adults - 1 mg, children - 0.5 mg; if necessary, re-introduction is possible; for intravenous administration, the maximum daily dose is 13 mg.
Clonazepam should be discontinued gradually, under the supervision of a physician.
If you miss another dose of clonazepam, you should immediately contact your doctor.
The initiation of use, as well as the abrupt withdrawal of clonazepam in patients with a history of epileptic seizures or with epilepsy, may accelerate the development of an epileptic state or seizures. Studies have shown that in 30% of patients who received anticonvulsants for 3 months, there was a decrease in the anticonvulsant activity of the drugs, in some cases, dose adjustments made it possible to restore this activity.
The possibility of drug dependence increases with the use of large doses of clonazepam, with its use for a long time, as well as in patients who have a history of drug and alcohol dependence. If it is necessary to stop treatment with clonazepam, then cancel it gradually, by reducing the dose, under the supervision of a physician, in order to reduce the possibility of developing a withdrawal syndrome. With the abolition of clonazepam, the simultaneous appointment of any other antiepileptic drug is necessary.
With the abrupt cancellation of clonazepam after prolonged use or treatment with high doses, a withdrawal syndrome occurs, which is characterized by fear, psychomotor agitation, insomnia, autonomic disorders, and in severe cases, mental disorders develop.
When counseling and treating women with epilepsy who wish to have a child, the following should be considered: do not stop anticonvulsant treatment if drugs are used to prevent seizures, as there is a high possibility of developing status epilepticus with concomitant fetal hypoxia and risk to his life. In some cases, when the frequency and severity of epileptic seizures is such that it can be assumed that if treatment is discontinued, a serious threat to the life of the fetus will not arise, it is possible to cancel therapy before and during pregnancy. It should be borne in mind that even moderate convulsions can harm the fetus or embryo.
With prolonged use of clonazepam in children, it is necessary to evaluate the risk and benefit due to the possibility of adverse side effects of clonazepam on the mental and physical development of the child, including delayed (that is, it may appear after several years). Use clonazepam with caution in inpatients, as the drug may suppress the cough reflex. During therapy with clonazepam, the intake of alcoholic beverages is unacceptable. With the development of paradoxical reactions, clonazepam should be discontinued. With prolonged use of clonazepam, it is necessary to periodically monitor the functioning of the kidneys and liver and the picture of peripheral blood. When taking clonazepam and within 3 days after its withdrawal, it is not recommended to drive vehicles, perform work that requires the speed of psychomotor reactions.

Contraindications for use

Hypersensitivity (including to other benzodiazepines), myasthenia gravis, angle-closure glaucoma, depression of the respiratory center, breast-feeding, severe respiratory, renal or hepatic insufficiency, for admission with panic disorders - age up to 18 years.

Application restrictions

Open-angle glaucoma (with adequate therapy), chronic alcoholism, chronic respiratory failure, drug dependence (including a history of it), pregnancy, impaired liver or kidney function.

Use during pregnancy and lactation

Clonazepam is contraindicated in breastfeeding. The use of clonazepam during pregnancy and during childbirth is possible only under strict indications, if the expected effect of treatment is higher than the possible risk to the fetus. In women who have taken clonazepam before or during pregnancy, it should be discontinued only if, in the absence of therapy, epileptic seizures are rare and mild, and also if the possibility of withdrawal symptoms and status epilepticus is assessed as low. There are reports that the use of anticonvulsants during pregnancy increases the incidence of birth defects in children.

Side effects of clonazepam

Nervous system and sense organs: drowsiness, ataxia, behavioral disturbances, visual disturbances (including blurred vision, diplopia, nystagmus), aphonia, abnormal movements of the eyeballs, dysarthria, choreiform twitching, dysdiadochokinesis, hemiparesis, headache, muscle weakness, dizziness, tremor, lethargy, disorientation, increased fatigue, decreased concentration and reaction speed, confusion, amnesia, suicidal attempts, depression, hallucinations, insomnia, hysteria, psychosis, paradoxical reactions (irritability, acute agitation, nervousness, anxiety, sleep disturbances, aggressive behavior, nightmares and others );
digestive system: sore gums, impaired salivation (dry mouth or hypersalivation), increased appetite, anorexia, nausea, constipation / diarrhea, gastritis, encopresis, hepatomegaly;
blood and circulatory system: palpitations, thrombocytopenia, leukopenia, anemia, eosinophilia;
respiratory system: bronchorrhea, rhinorrhea, respiratory depression;
leather: hirsutism, transient hair loss;
allergic reactions: swelling of the ankles and face, rash;
others: fever, decrease or increase in body weight, muscle pain, transient increase in the level of AST and ALT in the blood, lymphadenopathy, changes in libido, dehydration, dysuria, nocturia, enuresis, urinary retention.
Drug dependence, addiction, aftereffect and withdrawal syndromes are possible.

Interaction of clonazepam with other substances

The inhibitory effect of clonazepam on the central nervous system is enhanced by narcotic analgesics, alcohol, hypnotics, anticonvulsants, anxiolytics, neuroleptics (including phenothiazines, butyrophenones and thioxanthenes), tricyclic antidepressants, MAO inhibitors. Phenytoin, phenobarbital, carbamazepine accelerate the metabolism of clonazepam, reduce its blood levels by 30% and, accordingly, weaken the effect.

Overdose

With an overdose of clonazepam, depression of the central nervous system of varying degrees (from drowsiness to coma) occurs: prolonged confusion, severe drowsiness, depression of reflexes, coma, respiratory depression.
It is necessary: inducing vomiting and taking activated charcoal (if the patient is conscious), gastric lavage through a tube (if the patient is unconscious), symptomatic treatment, monitoring of vital functions (pulse rate, respiration, blood pressure), intravenous fluids (to increase diuresis), if necessary, connect the patient to a ventilator. As an antidote, flumazenil (a benzodiazepine receptor antagonist) can be used in a hospital setting, but flumazenil is not indicated for use in patients with epilepsy (the possibility of provoking epileptic seizures is high).

Trade names of drugs with the active ingredient clonazepam

By Decree of the Government of the Russian Federation of February 4, 2013 N 78, Moscow, clonazepam is included in the list of psychotropic substances whose circulation in the Russian Federation is limited and for which the exclusion of certain control measures is allowed in accordance with the legislation of the Russian Federation and international treaties of the Russian Federation (list III). Therefore, all drugs containing clonazepam are dispensed strictly by prescription.

Dosage form: tablets Ingredients:

Active substance: clonazepam 0.5 mg; 2 mg

Excipients: povidone, microcrystalline cellulose, sodium carboxymethyl starch, pregelatinized starch, sunset yellow dye E 11 0 / is included only in the "tablet 0.5 mg", colloidal silicon dioxide, magnesium stearate. Description:

Tablets 0.5 mg:

Tablets 2 mg:

Round, flat tablets of white or almost white color, with a risk dividing the tablet into 4 parts, on one side and the logo of the company "Remedica Ltd" on the other side.

Pharmacotherapeutic group:Anticonvulsant drug ATX:

Clonazepam

Pharmacodynamics:

An antiepileptic drug from the group of benzodiazepine derivatives. It has a pronounced anticonvulsant, as well as central muscle relaxant, anxiolytic, sedative and hypnotic effect.

Enhances the inhibitory effect of GABA on the transmission of nerve impulses. Stimulates benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of the brain stem and intercalary neurons of the lateral horns of the spinal cord. Reduces the excitability of the subcortical structures of the brain (limbic system, thalamus, hypothalamus), inhibits postsynaptic spinal reflexes.

The anxiolytic effect is due to the effect on the amygdala complex of the limbic system and manifests itself in a decrease in emotional stress, weakening anxiety, fear, anxiety.

The sedative effect is due to the effect on the reticular formation of the brain stem and nonspecific nuclei of the thalamus and is manifested by a decrease in neurotic symptoms (anxiety, fear).

Anticonvulsant action is realized due to increased presynaptic inhibition. In this case, the spread of epileptogenic activity that occurs in epileptogenic foci in the cortex, thalamus, and limbic structures is suppressed, but the excited state of the focus is not removed.

It has been shown that in humans it quickly suppresses paroxysmal activity of various types, incl. spike-wave complexes in absences (petit mal), slow and generalized spike-wave complexes, spikes of temporal and other localization, as well as irregular spikes and waves.

EEG changes of the generalized type are suppressed to a greater extent than those of the focal type. In accordance with these data, it has a beneficial effect in generalized and focal forms of epilepsy.

The central muscle relaxant effect is due to the inhibition of polysynaptic spinal afferent inhibitory pathways (to a lesser extent, monosynaptic ones). Direct inhibition of motor nerves and muscle function is also possible.

Pharmacokinetics:

After oral administration, it is absorbed from the gastrointestinal tract by 90%. The maximum plasma concentration is reached 1-3 hours after ingestion. Communication with plasma proteins - 5%. Penetrates through the blood-brain and placental barriers, penetrates into breast milk. is metabolized in the liver to practically inactive metabolites. The half-life is 20-60 hours. Excreted as metabolites in the urine (50-70%) and through the gastrointestinal tract (10-30%). About 0.5% of the dose taken is excreted by the kidneys unchanged.

Indications:

Means of the first row - epilepsy (adults, infants and young children): typical absence seizures (petit mal), atypical absence seizures (Lennox-Gastaut syndrome), nodding spasms, atonic seizures ("fall" or "drop-attack" syndrome).

The remedy of the second row is infantile spasms (West's syndrome).

Means of the III row - tonic-clonic convulsions (grand mal), simple and complex partial seizures and secondary generalized tonic-clonic convulsions.

Epileptic status (in / in the introduction).

Somnambulism, muscle hypertonicity, insomnia (especially in patients with organic brain lesions), psychomotor agitation, alcohol withdrawal syndrome (acute agitation, tremor, threatening or acute alcoholic delirium and hallucinations), panic disorders.

Contraindications:Respiratory center depression, severe COPD (progression of the degree of respiratory failure), acute respiratory failure, myasthenia gravis, coma, shock, angle-closure glaucoma (acute attack or predisposition), acute alcohol intoxication with weakening of vital functions, acute poisoning with narcotic analgesics and hypnotics, severe depression (suicidal tendencies may occur), pregnancy, lactation, hypersensitivity to clonazepam. Carefully:

Use with extreme caution in patients with ataxia, severe liver disease, severe chronic respiratory failure, especially in the stage of acute deterioration, with episodes of sleep apnea.

Use with caution in elderly patients, tk. they may have delayed elimination of clonazepam and reduced tolerance, especially in the presence of cardiopulmonary insufficiency.

Pregnancy and lactation:

The drug should not be used in pregnant women, unless the potential benefit to the mother outweighs the possible risk to the fetus (arrhythmia, hypothermia, lowering blood pressure, respiratory depression).

Use immediately before or during childbirth may cause muscle weakness in newborns. Dosage and administration:

inside. The dose and duration of therapy is determined by the doctor. Treatment should be started with low doses, increasing them gradually until the optimal therapeutic effect is obtained.

Adults: the initial dose is not more than 1.5 mg / day, divided into three doses.

The dose can be gradually increased by 0.5 mg every 3 days. The maintenance dose is set individually for each patient (reception). The maximum daily dose is 20 mg -1.5 mg / day for 2-3 doses. The maintenance daily dose is 3-6 mg. The maximum daily dose for children is 0.2 mg/kg body weight/day.

Children from 3 to 10 years old: 0.01-0.03 mg / kg / day and for 2-3 doses.

Elderly patients (over 65 years of age): dose reduction is recommended. The initial dose should not exceed 0.5 mg/day. Pa Patients with impaired renal function may need to reduce the dose of the drug.

Side effects:

From the side of the central nervous system: at the beginning of treatment - severe lethargy, fatigue, drowsiness, lethargy, dizziness, stupor, headaches; rarely - confusion, ataxia. When used in high doses, especially with long-term treatment - articulation disorders, diplopia, nystagmus; paradoxical reactions (including acute states of arousal); anterograde amnesia. Rarely - hyperergic reactions, muscle weakness - depression. With long-term treatment of some forms of epilepsy, an increase in the frequency of seizures is possible.

From the digestive system: rarely - dry mouth, nausea, diarrhea, heartburn, nausea, vomiting, loss of appetite, constipation or diarrhea, abnormal liver function, increased activity of hepatic transaminases and alkaline phosphatase, jaundice. In infants and young children, increased salivation is possible.

From the side of the cardiovascular system: decrease in blood pressure, tachycardia.

From the endocrine system: change in libido, dysmenorrhea, reversible premature sexual development in children (incomplete premature puberty).

From the respiratory system: with intravenous administration, respiratory depression is possible, especially during treatment with other drugs that cause respiratory depression; in infants and young children, bronchial hypersecretion is possible.

From the hematopoietic system: leukopenia, neutropenia, agranulocytosis, anemia, thrombocytopenia.

From the urinary system: urinary incontinence, urinary retention, impaired renal function.

Allergic reactions: urticaria, skin rash, itching, extremely rarely - anaphylactic shock.

Dermatological reactions: transient alopecia, pigmentation change.

Effect on the fetus: teratogenicity (especially the first trimester), depression of the central nervous system, respiratory failure and suppression of the sucking reflex in newborns whose mothers used the drug.

Others: addiction, drug dependence (both physical and mental - the risk of developing dependence increases with increasing dose and duration of treatment; a predisposition is observed especially in patients with a history of alcoholism or other types of addictions); decrease in blood pressure; rarely - weight loss, tachycardia, transient alopecia, pigmentation changes.

With a sharp decrease in the dose or discontinuation of the intake, the “withdrawal” syndrome (tremor, increased sweating, agitation, irritability, nervousness, sleep disturbances, severe anxiety, dysphoria, spasm of the smooth muscles of the internal organs and skeletal muscles, myalgia, depression, nausea, vomiting, tachycardia, convulsions and epileptic seizures, which may be a manifestation of the underlying disease; in severe cases, derealization, hyperacusis, paresthesia, photophobia, hyperesthesia, hallucinations may develop). Manifestations of the "withdrawal" syndrome are usually observed with an abrupt cessation of treatment. Therefore, if it is necessary to stop treatment, the dose of the drug should be reduced gradually under the supervision of a physician. With prolonged use, the development of drug dependence and the weakening of the effect of the drug as a result of the development of tolerance are possible.

Overdose:

Symptoms: drowsiness, confusion, paradoxical agitation, decreased reflexes, dysarthria, ataxia, nystagmus, tremor, bradycardia, shortness of breath or shortness of breath, severe weakness, decreased blood pressure, depression of cardiac and respiratory activity, coma.

Treatment: gastric lavage, activated charcoal. Symptomatic therapy (maintaining breathing and blood pressure). Hemodialysis is ineffective. The benzodiazepine antagonist flumazenil is not indicated in patients with epilepsy treated with benzodiazepines. In such patients, the antagonistic effect of benzodiazepines can provoke epileptic seizures.

Interaction:

Mutual enhancement of the effects of antipsychotic drugs (neuroleptics), tricyclic antidepressants, other antiepileptic and hypnotic drugs, general anesthetics, narcotic analgesics, centrally acting blood pressure lowering drugs, muscle relaxants and ethanol. Alcohol consumption during treatment with clonazepam other than provoke paradoxical reactions: psychomotor agitation, aggressive behavior or a state of pathological intoxication.

Pathological intoxication does not depend on the type and amount of alcohol consumed.

Reduces the effectiveness of levodopa in patients with parkinsonism.

It is potentially possible to increase the toxicity of zidovudine when used together.

With simultaneous use with valproic acid, it can lead to the development of status epilepticus of small seizures.

Inhibitors of microsomal oxidation, prolonging T1 / 2, increase the risk of developing toxic effects.

Inducers of microsomal liver enzymes (barbiturates, or) accelerate the metabolism of clonazepam without affecting its protein binding (does not induce enzymes involved in its metabolism), reduce the effectiveness of the drug.

Narcotic analgesics increase euphoria, leading to an increase in psychological dependence.

Antihypertensive drugs may increase the severity of lowering blood pressure.

Against the background of the simultaneous appointment of clozapine, it is possible to increase respiratory depression.

With the simultaneous use of phenytoin or primidone, an increase in the concentration of these drugs in the blood serum. lengthens the action.

Myelotoxic drugs increase the manifestations of hematotoxicity of the drug.

Tobacco smoking may reduce the effect of clonazepam.

Special instructions:

During long-term therapy with clonazepam, periodic laboratory monitoring of blood counts and liver function tests is recommended. During treatment with clonazepam and for 3 days after its completion, do not drink alcohol.

Influence on the ability to drive transport. cf. and fur.:While taking the drug, it is necessary to refrain from driving vehicles and performing work that requires the speed of psychomotor reactions. Release form / dosage:

Tablets 0.5 mg, 2 mg.

Package: By 10 tablets in a blister (P VH/Al) . 3 blisters, together with instructions for use, are placed in a cardboard box. Storage conditions:

The drug belongs to the list of potent substances PKKN.

In a dry, dust-proof place, or at a temperature not exceeding 25 ° C.

Keep out of the reach of children!

Shelf life: 5 years. Conditions for dispensing from pharmacies: On prescription Registration number: P N012884/01-2001 Date of registration: 25.06.2008 Expiration date: Perpetual Registration certificate holder: Remedica Ltd Cyprus Manufacturer: Representation: TRB Chemedica International S.A. Argentina Information update date: 29.01.2018 Illustrated Instructions

Clonazepam tablets belong to the pharmacological group of benzodiazepine derivatives. The group is serious, not intended for self-selection. All medicines included in it are dispensed only by prescription and require strict prescriptions, tk. have a depressant effect on the nervous system.

For the inhabitants, we recall that the depressant effect on the central nervous system is not at all synonymous with the action of a calming one. So if you're feeling nervous after talking to your boss or just can't sleep, taking clonazepam is not an option at all. Beware if someone with good intentions offers you a "good" pill.

To confirm our warnings, consider how clonazepam is characterized by instructions for use

The pharmaceutical industry produces clonazepam tablets in two dosages - 0.5 and 2 mg each. This form is very convenient, because. recommendations for the use of the drug suggest a gradual increase in dosage and gradual withdrawal, if necessary.

Tablets of 0.5 mg have a bright orange color, tablets of 2 grams are painted white. As auxiliary substances, the preparation contains:

potato starch or rice starch;
sodium carboxymethyl starch;
gelatin;
dye E 110 - only in a small dosage;
talc;
magnesium stearate;
lactose monohydrate.

Both the small and large tablets are round in shape, provided with a notch to help separate the tablet if necessary.

How the drug works

The instruction characterizes clonazepam as a drug that regulates emotional activity by inhibiting many structures of the central nervous system. Tablets reduce muscle tone, have a moderate hypnotic and sedative effect. Regular use of clonazepam can prevent generalized or focal seizures associated with epilepsy.

The annotation to the drug contains an important note that clonazepam is NOT USED in cases where nervous tension is associated with temporary problems of everyday life.

Therefore, specific indications for admission are:

Epilepsy in children;

Epilepsy in adults;

Prohibitions and direct contraindications

The drug is not used for the treatment of pregnant and lactating women, it is also not prescribed for severe renal and hepatic insufficiency. People with respiratory failure, with sleep apnea attacks at night should not take clonazepam. Porphyria, myasthenia gravis, alcohol poisoning are also categorical prohibitions for prescribing this medication.

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Where to buy medicine

The concept of deficiency is not associated with this drug - you can buy clonazepam at any state pharmacy, but strictly according to the prescription and exactly in the quantity and dosage indicated by the doctor. Even if the drug is prescribed for a long time, you will need a new prescription to buy it each time.

Despite the fact that the drug is produced in Poland, and not in Russia, the price of clonazepam is low. A package of 30 tablets at a dosage of 0.5 mg costs 91 - 97 rubles, for 30 tablets of 2 mg you will pay from 134 to 151 rubles. For any budget, the drug is quite affordable.

Reception features

The drug is prescribed with a gradual increase in dose. For adults, at the beginning of the intake, the maximum daily dosage is 1.5 mg. The daily dose is not taken at once, but at regular intervals, three times a day. Depending on how the drug is tolerated, the dose increases. Usually, an increase is recommended every 3 days, adding 0.5 mg to the daily dosage.

The addition continues until the daily dose reaches the recommended, 4 or 8 mg. During a gradual increase in the dose of clonazepam, feedback from patients is good, no side effects have been identified. But in situations of abrupt withdrawal of the drug, convulsive seizures, anxiety, and insomnia were noted.

Drug compatibility

If clonazepam is being prescribed, you should tell your doctor about any and all medicines you use.

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The action of clonazepam may be enhanced by the following groups of drugs:

Anesthetics;
Opium painkillers;
psychotropic drugs;
Antidepressants;
Antihistamines;
Some antihypertensive drugs.

With caution, clonazepam is prescribed if the patient is constantly taking antiarrhythmic drugs, in particular cordarone, amiodarone. When used together, undesirable side effects may increase, for example, movement coordination is disturbed.

Tablets are categorically incompatible with alcohol. The combined use of alcohol and clonazepam can cause paradoxical reactions - aggression, agitation, in some cases - loss of consciousness. In smokers, the effect of clonazepam may be reduced.

Unwanted Side Effects

Clonazepam is not a drug that has ever been withdrawn due to pronounced undesirable effects. However, like all other medicines, it has some unwanted effects that can occur when used incorrectly or overdosed.

This may be chest pain, bradycardia, abnormalities in the composition of morphological blood cells. At the beginning of treatment, temporary neurological disorders are possible - drowsiness, ataxia, delayed reactions, visual disturbances, headache. Dose adjustment helps to get rid of these symptoms, but more often they go away on their own. Sometimes there are dyspepsia, abdominal discomfort, loss of appetite. Mental disorders are rare, and mainly when the drug is used together with alcoholic beverages. If the dose is exceeded, gastric lavage is necessary, which is best done in a hospital.

A person taking clonazepam should be under constant medical supervision.

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Clonazepam is a well-known antiepileptic drug belonging to the benzodiazepine class. This remedy is prescribed in the treatment of many pathological conditions.

You can use the medication even for children from the first days of life, but before taking it, you should carefully study the instructions, since this drug, like a drug, has Clonazepam withdrawal syndrome, as well as a large number of contraindications and side effects.

The trade name of the drug, as well as the international non-proprietary name (INN) - Clonazepam.

Since 2011, Clonazepam has been on the list of essential medicines in the Russian Federation. Today it includes more than 600 medicines. Back in 2013, the drug was moved to the “third list” of radar stations, the sale of which is strictly controlled.

It is difficult to buy a drug in Moscow and other cities of Russia. Clonazepam is not available over the counter and is not available in all pharmacies. In the Moscow region and other regions of the Russian Federation, it is better to first check the availability in pharmacies. After purchase, the packaging with the product must be kept away from children in a dry place at temperatures up to + 25C.

Release form: tablets for oral administration and solution in ampoules of 2 ml, intended for intravenous injection.

Clonazepam tablets are produced in flat-cylindrical form with a chamfer.

You cannot buy Clonazepam without a prescription.

One package contains 30 or 50 tablets, the color of which is determined by the amount of the active ingredient:

0.5 mg - light orange;
1 mg - light purple;
2 mg - white color.

The active ingredient in this medication is clonazepam. The composition of the tableted Clonazepam also includes: starch, gelatin, lactose monohydrate, magnesium stearate and dyes. Clonazepam is an anticonvulsant drug that acts as a sedative and has hypnotic, muscle relaxant, and antiepileptic effects.

Instructions for Clonazepam says that the drug is well absorbed from the digestive system in a short time. Bioavailability is over 90%.

The principle of action is based on interaction with GABA A receptors. Clonazepam enhances the sensitivity of receptors to aminobutyric acid, due to which the transmission of nerve impulses slows down, the excitability of neurons decreases.

The drug has an anxiolytic effect, expressed in the dulling of excitement, nervous tension and fear. Night sleep improves and its duration increases. Clonazepam also reduces the tone of motor nerves and muscles, relieves epileptogenic tension of the cerebral cortex without affecting the source of excitation.

When is Clonazepam taken?

Instructions for use of Clonazepam contain the following indications for treatment:

Myoclonic and akinetic epilepsy, focal and temporal seizures in children and adults.
Fears and syndromes related to the expression of paroxysmal fear. Clonazepam is not prescribed for patients under 18 years of age.
Psychomotor agitation that appears during neurosis and mental disorders.
Personality disorder, manic-depressive psychosis.
Muscle hypertonicity, somnambulism, causeless panic and fear,.
Acute withdrawal syndrome.

Clonazepam is also used for essential tremor, but only when other treatments fail. It does not ensure the complete disappearance of symptoms, but only brings some relief. With VVD, for the relief of autonomic paroxysms, the attending physician can also prescribe Clonazepam.

Contraindications and restrictions

Clonazepam, like all drugs, has contraindications for use. They must be taken into account before taking.

Contraindications to the use of Clonazepam are:

respiratory failure;
respiratory depression;
acute intoxication with sleeping pills or narcotic analgesics;
predisposition to angle-closure glaucoma or its acute attacks;
shock or coma;
myasthenia gravis;
acute alcohol poisoning, as a result of which immunity is weakened and the functioning of vital organs and functions is disrupted;
severe depression;
pregnancy and lactation period;
hypersensitivity to the active ingredient in the composition of the drug.

Expert opinion

Alexandra Yurievna

General practitioner, associate professor, teacher of obstetrics, work experience 11 years.

Indications for the cautious appointment of Clonazepam are: hyperkinesia, cerebellar and spinal ataxia, chronic alcoholism, renal / hepatic failure, psychosis, bronchospastic syndrome, organic brain damage, sleep apnea.

In the presence of such diseases, before prescribing the drug, the attending physician compares the expected benefits of treatment and the risk.

How to take Clonazepam

Clonazepam is taken in small doses at the beginning of treatment, then the dosage is gradually increased until the optimal therapeutic result is achieved.

The initial daily dose is prescribed individually and depends on the age of the patient:

adult patients - no more than 1 mg.
elderly patients - it is necessary to take no more than 500 mcg;
children under 5 years old - initially up to 250 mcg can be prescribed;
children 5-12 years old - no more than 500 mcg.

The daily dose prescribed by the doctor should be divided into 3-4 doses.

After several weeks of treatment, maintenance doses are prescribed:

adult patients - 4-8 mg / day, the maximum daily dose for epilepsy is 20 mg;
elderly patients and children who are under 18 years old - no more than 6 mg / day.

With intravenous administration of Clonazepam, the solution is administered drip or slowly in a jet, while in order to avoid inflammation of the walls of the veins and blood vessels, a special solvent is required. The injection solution is prepared immediately before administration. Cancellation of Clonazepam should occur gradually.

When prescribing Clonazepam, the daily dose and duration of treatment are selected only by the attending physician, and only when an accurate diagnosis is determined and the results of all necessary tests are obtained.

Instructions for use of Clonazepam from Yandex.Health.

Cases of overdose

In case of an overdose, drowsiness, disorientation, slurred speech may appear, and in difficult situations, even coma is possible.

Also, an overdose of Clonazepam can cause:

confused mind;
emotional arousal;
ataxia;
decreased reflexes;
low blood pressure;
weakness;
bradycardia;
breathing problems.

If signs of an overdose appear, symptoms should be treated. In case of accidental ingestion of Clonazepam with other drugs that depress the central nervous system, or alcohol, be sure to provoke vomiting and rinse.

Side effects

Possible side effects when taking Clonazepam:

chest pain and bradycardia;
ataxia, confusion, hallucinations, dizziness and headaches;
lethargy, depression, tremor and apathy;
lack of appetite, nausea, increased salivation or dry mouth;
failure of the kidneys and liver, pain when urinating, urinary incontinence;
bronchial hypersecretion, respiratory depression;
insomnia, aggression and nervous excitement, unreasonable fear and anxiety;
hair loss, itching, skin rash;
weight loss.

Taking the drug, drug dependence may occur, with a sharp decrease in dose or cancellation - Clonazepam withdrawal syndrome.

Dosage of the main anticonvulsants.

Long-term drug dependence and non-compliance with dosages explain why Clonazepam is not available without a prescription. If there are side effects, it is necessary to cancel the appointment and visit a doctor.

At the appointment, the doctor will tell you how to get off Clonazepam and how to replace Clonazepam.

Clonazepam analogues: Rivotril and Clonotril. The main synonyms of Clonazepam: Antelepsin, Klonopin, Ictoril, Iktoviril.

Phenazepam can also be called an analogue of Clonazepam. Clonazepam and Phenazepam have similar medicinal properties, they differ in anxiolytic action: Phenazepam is much stronger than clonazepam (the duration of the effect differs by 5 times).

It is possible to use analogues and substitutes only after agreement with the doctor. Drugs are purchased by prescription only.

special instructions

To prevent the increase in epileptic seizures, it is necessary to gradually switch to another antiepileptic drug. With the transition, the danger of apathy and sedation increases. Do not drink alcohol while taking Clonazepam. With prolonged use of the drug, you should regularly donate blood for tests.

The use of clonazepam during pregnancy develops dependence in the fetus, the result of treatment will be clonazepam withdrawal syndrome in the child.

Taking this medication while breastfeeding can develop neuropsychiatric abnormalities and delay the physical development of the child. The medicine Clonazepam adversely affects the performance of complex work and transport management.

Not all indications for the use of Clonazepam are contained in the instructions. Sometimes the attending physician pursues other therapeutic goals by prescribing this medicine.

Switching from Alprazolam to Clonazepam

Despite the similar effectiveness of Alprazolam and Clonazepam in the treatment of panic disorders, when the patient develops fear and anxiety between doses of Alprazolam, and there are difficulties in reducing the dosage and stopping the drug, it is useful to switch from Alprazolam to Clonazepam.

Switching from Alprazolam to Clonazepam will help solve these problems, since Clonazepam is quite effective and can replace Alprazolam. The main difference between these two drugs is the half-life. Alprazolam has a half-life of 1-2 days, while clonazepam has a longer half-life of 2-4 days.

The minimum time required to establish a constant concentration of clonazepam in the blood is 1 week.

Conclusion

Clonazepam is an anticonvulsant drug that has a number of contraindications and side effects. It must be used with caution by children and the elderly. Clonazepam is not sold without a prescription, the need for admission is determined by a specialist.

Only correctly calculated dosage and regular intake can lead to the achievement of the maximum positive result. Clonazepam, as a narcotic, with prolonged use or taking large doses, can cause dependence.

And abrupt cancellation or reduction in dosage can provoke clonazepam withdrawal syndrome. When such situations arise, you need to visit a doctor and pick up analogues.

Currently not available for sale. Last fixed price*: 149 rubles.

Instructions for use

Clonazepam can be used in infants. It is effective against seizures, epileptic seizures and other health problems. Consider this drug in more detail.

Composition, pharmacokinetics and pharmacodynamics

The active substance is clonazepam.

Available in the form of tablets, the dosage of which can be 0.5 or 2 mg. The first option is flat light orange tablets with a cross line. The second option (2 mg each) is white pills with a cruciform risk, biflat. Are issued on 30 pieces.

Clonazepam belongs to the anticonvulsant pharmacological group and is a benzodiazepine derivative. The action of clonazepam is manifested in the weakening of anxiety, fear and emotional stress.

Pharmacokinetics: antiepileptic, central, sedative and hypnotic with a high absorption rate and long-term action. Its maximum concentration is reached in the blood within 60-120 minutes, metabolized in the liver and excreted by the kidneys during the day.

Indications for use

It is prescribed for children and adults, often used in pediatrics for infants. It is used in all forms of epilepsy, accompanied by twitching of muscle bundles (convulsive seizures, called myoclonic). Often the drug is used as a hypnotic and sedative, especially in people with organic brain damage.

Main indications for the use of clonazepam.

Epilepsy.
psychomotor crises.
Insomnia.
muscle hypertonicity.
Anxiety, panic disorder, hallucinations.

Contraindications

The drug of this group of pharmacology is contraindicated in the presence of individual intolerance, disorders of the kidneys or liver, all types of addictions (alcohol, drugs, drugs), myasthenia gravis, respiratory failure, coma, depression with possible suicidal tendencies.

Pregnancy and lactation

Contraindicated.

Mode of application

When prescribing Clonazepam in a large dosage of 2 mg, adults are advised to start taking half a tablet per day.

infants up to one year of age are prescribed up to 1 mg;
children under five years of age are prescribed up to 3 mg;
up to twelve years - up to 6 mg.

The maximum daily dosage for children is calculated by weight, for each kilogram - 0.2 mg. On average, this is 2 tablets of 0.5 mg, the maximum possible dosage is 8 pcs.

Side effects

Blurred vision, depression, increased heart rate, impaired kidney and liver function, depressed breathing, allergic reactions, anemia, temporary memory impairment, and others.

An overdose of clonazepam can be manifested by several of the symptoms listed above, or others (shortness of breath, blurred speech, increased drowsiness, trembling ...). If you have any of the symptoms after taking the medicine, you should stop it and consult a doctor. In most cases, gastric lavage will be required.

Attention! Alcohol should not be taken with clonazepam. When taking it, alcohol-containing drinks should be completely abandoned.