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.
§
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.
§
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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