CLONAZEPAM


Drug Name
Generic Name : clonazepam

Brand Name: Apo-Clonazepam (CAN), Gen-Clonazepam (CAN), Klonopin,
Klonopin Wafers, Nu-Clonazepam (CAN), Rivotril (CAN)

Classification: Benzodiazepine, Antiepileptic

Pregnancy Category X 

Controlled Substance C-IV

Dosage & Route
§  Individualize dosage; increase dosage gradually to avoid adverse effects; drug is available only in oral dosage forms.

Adults 
§  Seizure disorders: Initial dose should not exceed 1.5 mg/day PO divided into three doses; increase in increments of 0.5–1 mg PO every 3 days until seizures are adequately controlled or until side effects preclude further increases. Maximum recommended dosage is 20 mg/day.    Nursing Path
§  Panic disorders: Initial dose 0.25 mg PO bid; gradually increase to a target dose of 1 mg/day.

Pediatric Patients> 10 YR OR 30 KG 
§  Initially, 0.01–0.03 mg/kg/day PO; do not exceed 0.05 mg/kg/day PO, given in two or three doses. Increase dosage by not more than 0.25–0.5 mg every third day until a daily maintenance dose of 0.1–0.2 mg/kg has been reached, unless seizures are controlled by lower dosage or side effects preclude increases. Whenever possible, divide daily dose into three equal doses, or give largest dose at bedtime.

Therapeutic actions 

§  Clonazepam is an effective anticonvulsant. It raises the threshold for propagation of seizure activity and prevents generalization of focal or local activity. Clinically, it improves focal epilepsy and generalized seizures. It is also believed to enhance the activity of GABA, and acts as anxiolytic.

Indications      Nursing Path

§  Used alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures; may be useful in patients with absence (petit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug, often within 3 mo of therapy (may respond to dosage adjustment); treatment of panic disorder with or without agoraphobia
§  Unlabeled uses: Periodic leg movements during sleep; hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, neuralgias

Adverse effects 

§  Drowsiness, fatigue, muscular hypotonia, coordination disturbances, dizziness, vertigo, anorexia, visual disturbances, libido changes.
§  Potentially Fatal: Salivary or bronchial hypersecretion leading to respiratory problems (children). May produce diminished reflexes or coma. Rarely, blood dyscrasias.

Contraindications   Nursing Path

§  Hypersensitivity to benzodiazepines, acute pulmonary insufficiency, acute narrow angle glaucoma.

Nursing considerations
CLINICAL ALERT! Name confusion has occurred between Klonopin (clonazepam) and clonidine; use caution.

Assessment 
§  History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; liver or renal impairment, debilitation.
§  Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests.

Interventions 
§  Monitor addiction-prone patients carefully because of their predisposition to habituation and drug dependence.
§  Monitor liver function and blood counts periodically in patients on long-term therapy.    Nursing Path
§  WARNING: Taper dosage gradually after long-term therapy, especially in patients with epilepsy; substitute another antiepileptic.
§  Monitor patient for therapeutic drug levels: 20–80 ng/mL.
§  If the patient has epilepsy, arrange for patient to wear medical alert identification indicating patient has epilepsy and is receiving drug therapy.

Teaching points 
§  Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting health care provider.
§  Avoid alcohol, sleep-inducing, or over-the-counter drugs.
§  Avoid pregnancy; serious adverse effects can occur. Using barrier contraceptives is advised while taking this drug.
§  It would be advisable to wear or carry a medical alert identification indicating your diagnosis and drug therapy.
§  You may experience these side effects: Drowsiness, dizziness (may become less pronounced; avoid driving or engaging in other dangerous activities); GI upset (take drug with food); fatigue; dreams; crying; nervousness; depression, emotional changes; bed-wetting, urinary incontinence.
§  Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.



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