Clonazepam

Clonazepam is a benzodiazepine that is used to treat anxiety disorders as well as to temporarily relieve acute alcohol withdrawal symptoms and anxiety symptoms. Clonazepam can be administered off-label for the treatment of a number of illnesses, including premenstrual syndrome, social anxiety, insomnia, and PTSD.
Federal and state laws limit clonazepam as an illicit substance because, like other benzodiazepines, it is susceptible to dependency and misuse.

How does clonazepam work?

The way that clonazepam works pharmacologically in the brain at certain receptor locations may help to explain why it is such an excellent anxiety treatment. Receptors are certain areas on the membrane of nerve cells that receive signals from neurotransmitters, which are neurochemicals. A neurotransmitter attaches to the receptor and travels along the neuron to convert the neurochemical signal into an electrical or other chemical signal. These particular receptors are also referred to as benzodiazepine receptors.  

• The neurotransmitter γ-aminobutyric acid (GABA) in that area of the brain is facilitated in its inhibitory effect by the combined action of benzodiazepines on the receptors.

It appears that benzodiazepines’ anxiolytic, sedative, and anticonvulsant effects are due to their interaction with GABA receptors.

 What is the recommended dose of clonazepam?

Clonazepam is often started at 0.5 mg two to three times per day and increased to a recommended dosage of 1-4 mg / day given in divided doses. Up to a maximum of 6–8 mg/day, the dosage may be raised based on how severe the symptoms are.

•  Compared to benzodiazepines with shorter half-lives, such alprazolam, withdrawal symptoms from clonazepam are often milder due to its prolonged duration of action.  

What happens when you take an overdose of clonazepam?

Oral benzodiazepine overdoses are rarely lethal. Benzodiazepines sometimes cause mortality when taken with other CNS depressants, particularly alcohol, narcotics, and barbiturates.  

Drowsiness, confusion, somnolence, weariness, dropped coordination, clumsiness while walking (ataxia), and sluggish reflexes are some of the mild indications of benzodiazepine overdose. 

When taken alone, benzodiazepines hardly cause death. When some drugs participate in benzodiazepine overdose, severe symptoms such as trouble breathing, slowing heart rate, decreased blood pressure, lack of coordination, and loss of consciousness lead to coma and death.

• Every potential overdose should be considered an emergency at the ER. The prescription bottle of the drug along with any extra drugs linked to the overdose should also be brought, as the data on the prescription label can help the treating physician estimate the quantity of pills consumed.

What are the side effects of clonazepam?

Sedation and drowsiness are the most often reported, particularly in the early stages of therapy. Other common symptoms include difficulty focusing and remembering things, a dissociative or “spacey” feeling, and trouble with coordination. 

• Constipation, dizziness, change in appetite, decreased interest in sexual intercourse.
• Suicidal thoughts or behaviors, hyperventilation, change in consciousness, confusion, loss of memory, Seizure and palpitations

In some individuals, benzodiazepines may possess paradoxical effects. In susceptible individuals, the drug stimulates enthusiasm, aggression, hostility, uncontrolled behavior, and wrath rather than the expected depressive effects. These reactions are especially common in the elderly, people with brain injuries, and people with personality and impulse control difficulties.

• Dizziness, headache, nausea, facial or muscle twitching, Muscle weakness, Balance disorder, Painful or difficult urination, Chills, slow heart rate, slow breathing , and dark urine.

What are the precautions of clonazepam use?

• Clonazepam, like other benzodiazepines, is categorized as a restricted substance due to its potential for misuse and dependence, according to state and federal laws. 
• The drug impairs awareness and coordination; therefore, patients should use caution when driving or performing other tasks that require alertness while taking this medicine. 

Seniors may be more vulnerable due to impaired coordination and reflexes, perhaps leading to falls and injuries. 

• Co-administration with other central nervous system (CNS) depressants such as alcohol, opioids, and barbiturates may exacerbate these CNS effects. So quit drinking while taking the drug. 
• Prolonged use of benzodiazepines as clonazepam could end in dependence. When the medicine is abruptly stopped, the withdrawal symptoms may appear. Headaches, vomiting, decreased attention, confusion, tremors, muscle cramps, and seizures are among withdrawal symptoms. 
• Benzodiazepines such as clonazepam are systemically acting depressants that might reduce breathing. This is especially challenging for people with chronic obstructive lung disease and emphysema. The respiratory depressive effect of benzodiazepines may further suppress respiratory drive in these patients, putting them at greater risk for respiratory depression and death. 

If you miss a dose, take it right away. If it is near the next planned dose, cancel the missed dose and resume your normal dosing schedule. Avoid taking double the prescribed dose.

• Clonazepam can be taken before or after meals. 
• Keep the medication in the original labeled, light-resistant container, away from heat and moisture, to avoid drug degradation by them. 
• Keep Clonazepam away from your children.

How does clonazepam affect pregnancy and lactation?

• Clonazepam is classified as pregnancy category D.

Benzodiazepines and their metabolites are known to cross the placenta and accumulate in the fetal circulation. 

• They are associated with a risk of congenital malformations when used during pregnancy, causing cleft lip and heart deformities in the fetus. 
• Benzodiazepines such as clonazepam should be avoided during pregnancy, particularly in the first trimester. The use of benzodiazepines during pregnancy should be considered only when the need for the medication outweighs its risk and alternative therapies have failed. 

Nursing mothers should not take clonazepam, because it will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should be discontinued.

What are the drugs contraindicated with clonazepam

Clonazepam is metabolized hepatically by cytochrome P450 by glucuronidation to give an inactive metabolite.

• So coadministration of any Cytochrome P450 inhibitors, inducers, or metabolites could affect its excretion and concentration.
• CNS depressants (alcohol, narcotics, barbiturates, and hypnotics) and antihistamines could affect coordination and breathing while increasing drowsiness.

• Cimetidine, Nefazodone, Erythromycin, Itraconazole, Ciprofloxacin, fluoxetine, ketoconazole, propranolol, divalproex sodium, propoxyphene, and disulfiram; these medications may inhibit the metabolism of clonazepam, thus increasing the level and pharmacological effects of the drug and producing excessive sedation and other adverse CNS effects.