Home Drug Guide Clonazepam

Drug Guide

Generic Name

Clonazepam

Brand Names Klonopin, Klonopin Rapidly Disintegrating

Classification

Therapeutic: Antiepileptic, Anxiolytic

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Seizure disorders (absence seizures, myoclonic seizures, Lennox-Gastaut syndrome)
  • Epilepsy
  • Panic disorder with or without agoraphobia

Mechanism of Action

Enhances the effect of gamma-aminobutyric acid (GABA) at GABA-A receptor sites, leading to sedative, anticonvulsant, and muscle-relaxant effects.

Dosage and Administration

Adult: Typically 0.25 mg twice daily, titrated up as needed and tolerated; maximum dose varies based on condition.

Pediatric: Dosing varies by age and condition; usually starting at 0.01-0.03 mg/kg/day in divided doses.

Geriatric: Start low, e.g., 0.25 mg at bedtime, titrate cautiously due to increased sensitivity.

Renal Impairment: Use with caution, dose adjustments may be necessary.

Hepatic Impairment: Use with caution; dose adjustment may be needed.

Pharmacokinetics

Absorption: Well absorbed with oral administration.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Primarily hepatic via CYP3A4 to inactive metabolites.

Excretion: Renal excretion of metabolites.

Half Life: 18-50 hours, duration varies depending on individual metabolism.

Contraindications

  • Hypersensitivity to benzodiazepines.
  • Acute narrow-angle glaucoma.

Precautions

  • History of substance abuse, depression, or suicidal ideation; use cautiously in older adults.
  • Pregnancy Category D; risks in pregnancy, especially for congenital malformations, should be considered.

Adverse Reactions - Common

  • Drowsiness (Very common)
  • Dizziness (Common)
  • Fatigue (Common)
  • Ataxia (Uncommon)

Adverse Reactions - Serious

  • Respiratory depression (Rare)
  • Dependence and withdrawal syndrome (Varies with duration and dose)
  • Paradoxical reactions (agitation, aggression) (Rare)

Drug-Drug Interactions

  • CNS depressants (opioids, alcohol, other benzodiazepines) — may enhance sedation and respiratory depression.
  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) — may increase clonazepam levels.
  • CYP3A4 inducers (e.g., carbamazepine) — may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for therapeutic effects (seizure control, reduced anxiety).

Diagnoses:

  • Risk of injury due to sedation or ataxia.
  • Risk of dependence.

Implementation: Administer as prescribed, monitor for adverse effects, and avoid abrupt discontinuation to prevent withdrawal.

Evaluation: Assess seizure frequency and severity; monitor for side effects.

Patient/Family Teaching

  • Do not operate heavy machinery or drive until effect is known.
  • Avoid alcohol and other CNS depressants.
  • Take medication exactly as prescribed; do not discontinue abruptly.
  • Report worsening depression or suicidal thoughts.

Special Considerations

Black Box Warnings:

  • Potential for abuse, misuse, and dependence.
  • Risks in pregnancy, including congenital malformations.

Genetic Factors: Metabolism varies with CYP3A4 activity, which can be affected by genetic polymorphisms.

Lab Test Interference: May alter liver function tests or CBC.

Overdose Management

Signs/Symptoms: Excess sedation, respiratory depression, coma.

Treatment: Supportive care, airway management, activated charcoal if ingestion was recent, and flumazenil (benzodiazepine antagonist) under careful monitoring.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable within the expiration date on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.