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Clonazepamsold under the brand name Klonopin among others, is a medication used to prevent and treat seizurespanic disorderand for the movement disorder known as akathisia. Common side effects include sleepiness, poor coordination, and agitation. Clonazepam was initially patented in and went on sale in in the United States from Roche. Clonazepam is prescribed for epilepsy and panic disorder with or without agoraphobia.

Clonazepam, like other benzodiazepines, while being a first-line treatment for acute seizures, is not suitable for the long-term treatment of seizures due to the development of tolerance to the anticonvulsant effects. Clonazepam has been found effective in treating epilepsy in children, and the inhibition of seizure activity seemed to be achieved at low plasma levels of clonazepam.

Alprazolam has been found to be effective in the acute control of non-convulsive status epilepticus ; however, the benefits tended to be transient in many of the people, and the addition of phenytoin for lasting control was required in bromazepam patients. It is also approved for treatment of typical and atypical absences, infantile myoclonicmyoclonic and akinetic seizures.

The effectiveness of clonazepam in the short-term treatment of panic disorder has been demonstrated in controlled how many 1mg xanax will kill you trials. Some long-term trials have suggested a benefit of clonazepam for up to three years without the development of tolerance bromazepam these trials were not placebo -controlled. Restless legs syndrome can be treated using clonazepam as a third-line treatment option as the use of clonazepam is still investigational.

The long-term effects of clonazepam can include depression[5] disinhibitionand sexual dysfunction. Clonazepam, like other benzodiazepines, may impair a person's ability to drive or operate machinery. The central nervous system depressing effects of the drug can be intensified by alcohol consumption, and therefore alcohol should be avoided while taking this medication.

Benzodiazepines have been shown to cause dependence. Patients dependent on clonazepam should be slowly titrated off under the supervision of a qualified healthcare professional to reduce the intensity of withdrawal or rebound symptoms. Benzodiazepines such as clonazepam can be very effective in controlling status epilepticusbut, when used for longer periods of time, some potentially serious side-effects may develop, such as interference with cognitive functions and behavior. Physiological dependence was demonstrated by flumazenil -precipitated withdrawal.

A recurrence of symptoms of the underlying disease should be separated from withdrawal symptoms. Like all benzodiazepines, clonazepam is a GABA-positive allosteric modulator. High dosage and long-term use increase the risk and severity of dependence and withdrawal symptoms. Withdrawal seizures and psychosis can occur in severe cases of withdrawal, and anxiety and insomnia can occur in less severe cases of withdrawal.

A gradual clonazepam diazepam in dosage reduces the severity diazepam clonazepam the benzodiazepine withdrawal syndrome. Due to the risks of tolerance and withdrawal seizures, clonazepam is generally not recommended for the long-term management of epilepsies. Increasing the dose can overcome the effects of tolerance, but tolerance to the higher dose may occur and adverse effects may intensify. The mechanism of tolerance includes receptor desensitization, down regulation, receptor decoupling, and alterations in subunit composition and in gene transcription coding.

Tolerance to the anticonvulsant effects of clonazepam occurs in both animals and humans. In humans, tolerance to the anticonvulsant effects of clonazepam occurs frequently. The degree of tolerance is more pronounced with clonazepam than with chlordiazepoxide. Abrupt or over-rapid withdrawal from clonazepam may bromazepam in the development of the benzodiazepine withdrawal syndrome, causing psychosis characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations.

Anti-epileptic drugs, benzodiazepines such as clonazepam in particular, should be reduced in dose slowly and diazepam clonazepam when discontinuing the drug to mitigate withdrawal effects. Coma can be cyclic, with the individual alternating from a comatose state to a hyper-alert state of consciousness, which bromazepam in a 4-year-old boy who suffered an overdose of clonazepam. Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, and fainting.

Clonazepam and 7-aminoclonazepam may clonazepam diazepam quantified in plasmaserum or whole blood in order to monitor compliance in those receiving the drug therapeutically. Results from such tests can be used to confirm the diagnosis in potential poisoning "bromazepam" or to assist in the forensic investigation in a case of fatal overdosage.

Both the parent drug and 7-aminoclonazepam are unstable in biofluids, and therefore specimens should be preserved with sodium fluoride, stored at the lowest possible temperature and analyzed quickly to minimize losses. The elderly metabolize benzodiazepines more slowly than younger individuals and are also more sensitive to the effects of benzodiazepines, even at similar blood plasma levels. Doses for the elderly are recommended to be about half of that given to younger adults and are to be administered for no longer than two weeks.

Long-acting benzodiazepines such as clonazepam are not generally recommended for the elderly due to the risk of drug accumulation. The elderly are especially susceptible to increased risk of harm from motor impairments and drug accumulation side effects. Benzodiazepines also require special precaution if used by individuals that may be pregnant, alprazolam or drug-dependent, or may have comorbid psychiatric disorders. Clonazepam is not recommended for use in those under Use in very young children may be especially xanax after quitting alcohol. Of anticonvulsant drugs, behavioural disturbances occur most frequently with clonazepam and phenobarbital.

Doses higher than 0. Clonazepam may aggravate hepatic porphyria. Clonazepam is not recommended for patients with chronic schizophrenia. A double-blinded, placebo-controlled study found clonazepam increases violent behavior in individuals with chronic schizophrenia. Clonazepam has similar effectiveness to other benzodiazepines at often a lower dose. Clonazepam decreases the levels of carbamazepine[87] [88] and, bromazepam, clonazepam's level is reduced by carbamazepine.

Azole antifungals, such as ketoconazolemay inhibit the metabolism of clonazepam. Combined use of clonazepam with certain antidepressantsantiepilepticssuch as phenobarbitalphenytoin and carbamazepinesedative antihistaminesopiatesantipsychoticsnonbenzodiazepine hypnotics like zolpidem and alcohol may result in enhanced sedative effects. There is some medical evidence of various malformations, e.

The data are also inconclusive on whether benzodiazepines such as clonazepam cause "alprazolam" deficits or decreases in Tramadol article conclusion troubling in the developing fetus when taken by the mother during pregnancy. Clonazepam, when used late in pregnancy, may result in the development of a severe benzodiazepine withdrawal syndrome in the neonate.

Withdrawal symptoms from benzodiazepines in the neonate may include hypotoniaapnoeic spells, cyanosis and impaired metabolic responses to cold stress. The safety profile of clonazepam during pregnancy is less clear than that of other benzodiazepines, and if benzodiazepines are indicated during pregnancy, chlordiazepoxide and diazepam may be a safer choice. The use of clonazepam during pregnancy should only occur if the clinical benefits are believed to outweigh the clinical risks to the fetus.

Caution can phentermine be used for narcolepsy also required if clonazepam is used during breastfeeding. Possible adverse effects of use of benzodiazepines such as clonazepam during pregnancy include: Neonatal withdrawal syndrome associated with benzodiazepines include hypertoniahyperreflexiarestlessnessirritabilityabnormal sleep patterns, inconsolable crying, tremors or jerking of the extremities, bradycardiacyanosissuckling difficulties, apnearisk of aspiration of feeds, diarrhea and vomiting, and growth retardation.

This syndrome can develop between 3 days to 3 weeks after birth and can have a duration of up to several months. The pathway by which clonazepam is metabolized is usually impaired in newborns. If clonazepam is used during bromazepam or breast feedingit is recommended bromazepam serum levels is lunesta similar to ambien clonazepam are monitored and bromazepam signs of central nervous system depression and apnea are also checked for.

In many cases, non-pharmacological treatments, such as relaxation therapy, psychotherapy and avoidance of caffeinecan be an effective and safer alternative to the use of benzodiazepines for anxiety in pregnant women. Clonazepam acts by binding to the benzodiazepine site of the GABA receptors, which enhances the electric effect of GABA binding on neurons, resulting in an increased influx of chloride ions into the neurons. This further results in an inhibition of synaptic transmission across the central nervous system.

Benzodiazepines do not have any effect on the levels of GABA in the brain. Clonazepam does, however, affect glutamate decarboxylase activity. It differs from other anticonvulsant drugs it was compared to in a study. Benzodiazepines, including clonazepam, bind to mouse glial cell membranes with high affinity. This has been conjectured as a mechanism for high-dose effects on seizures in the study. Clonazepam is a chlorinated derivative of nitrazepam. Clonazepam is lipid-soluble, rapidly crosses the blood—brain barrierand penetrates the placenta.

It is extensively metabolised into pharmacologically inactive metabolites. Clonazepam is metabolized extensively via nitroreduction by cytochrome P enzymes, including CYP3A4. Erythromycinclarithromycinritonaviritraconazoleketoconazolenefazodonecimetidineand grapefruit juice are inhibitors of CYP3A4 and can affect the metabolism of benzodiazepines. In some individuals, however, peak blood concentrations were reached at 4—8 hours. Clonazepam passes rapidly into the central nervous system, with levels in the brain corresponding with levels of unbound clonazepam in the blood serum.

Plasma levels of clonazepam can vary as much as tenfold between different patients. Clonazepam is largely bound to plasma proteins. Bromazepam is effective for 6—8 hours in children, and 6—12 in adults. A Bromazepam government study of emergency department ED visits found that sedative-hypnotics were the most frequently implicated pharmaceutical drug bromazepam ED visits, with benzodiazepines accounting for the majority of these.

Clonazepam was the second most frequently implicated benzodiazepine in ED is 2mg of xanax a high dose. Alcohol alone was responsible for over twice as many ED visits than clonazepam in the same study. The study examined the number of times bromazepam non-medical use of certain drugs was implicated in an ED visit.

The criteria for non-medical use in this study were purposefully broad, and include, for example, drug abuseaccidental or intentional overdoseor adverse reactions resulting from legitimate use of the bromazepam. Clonazepam was approved in the United States as a generic drug in and is now manufactured and marketed by several companies. Clonazepam is available as tablets and orally disintegrating tablets wafers an oral solution dropsand as a solution for bromazepam or intravenous infusion.

From Wikipedia, the free encyclopedia. Not to be confused with clozapineclonazolamor clorazolam. D Evidence of risk. S4 Prescription only BR: Class B1 Psychoactive drugs CA: Archived from the original on Bromazepam Aug 15, Therapeutic uses of alprazolam toxin. A Review of the Literature". A Historical Dictionary of Psychiatry.