Clonazepam anticonvulsant

Support is scant for the efficacy of anticonvulsant agents in the treatment of OCD (Jenike 1990 Joffe and Swinson 1987). If there is a role for carbamazepine in OCD, it may be in patients with clinical or electroen-cephalographic evidence of a seizure disorder (Jenike and Brotman 1984 Khanna 1988). The anti-OC efficacy of combined SRI-carbamazepine treatment has not been adequately studied. Sodium valproate was found ineffective in two cases of OCD (McElroy and Pope 1988 McElroy et al. 1987). However, one author has suggested that sodium valproate may be a useful pretreatment for patients with OCD who might otherwise tolerate SRIs poorly (Deltito 1994). The anticonvulsant clonazepam is discussed earlier in this chapter. 

Benzodiazepines useful to treat anxiety generally have an intermediate to long elimination ty2 (alprazolam and diazepam), and those primarily used as anticonvulsants (clonazepam) have a long ty2. Elimination ty2 is clearly not the sole determinant of duration of action of benzodiazepines. In some cases, the rate of drug redistribution from the CNS may be an even more important factor. For instance, midazolam (b/2=l to 4 hours) and diazepam (fi/2 - 30 to 56 hours) were demonstrated to have equivalent recovery times for single-dose, short-term sedation. For this application, the distribution kinetics for diazepam are more significant than elimination fi/2. 

For this, antidotic formulas are supplemented with anticonvulsants of different chemical structures (diazepam, clonazepam, phenazepam, etc.). 

Anxiolytics clonazepam, diazepam, temazepam, triazolam, alprazolam, midazolam, buspirone Anticonvulsants ethosuximide, carbamazepine Calcium channel blockers diltiazem, felodipine, nifedipine, verapamil... 

The normal body temperature is 36.8°C. Babies under 6 months of age who have a higher temperature than 37.7°C should be referred on the same day. Babies over 6 months should be referred if their temperature is above 38.2°C. Babies who have had a temperature-related convulsion lasting 15 minutes or longer should receive pharmacotherapy in the form of either lorazepam, diazepam or clonazepam. Febrile convulsions in children usually cease spontaneously within 5-10 minutes and are rarely associated with significant sequelae and therefore long-term anticonvulsant prophylaxis is rarely indicated. Parents should be advised to seek professional advice when the child develops fever so as to prevent the occurrence of high body temperatures. 

Benzodiazepines are the drugs of choice for status epilepticus (see above) however, development of tolerance renders them less suitable for long-term therapy. Clonazepam is used for myoclonic and atonic seizures. Clobazam, a 1,5-benzodiazepine exhibiting an increased anticonvulsant/seda-tive activity ratio, has a similar range of clinical uses. Personality changes and paradoxical excitement are potential side effects. 

Carbamazepine also can induce the enzymes that metabolize other anticonvulsant drugs, including phenytoin, primidone, phenobarbital, valproic acid, clonazepam, and ethosuximide, and metabolism of other drugs the patient may be taking. Similarly, other drugs may induce metabolism of carbamazepine the end result is the same as for autoinduction, and the dose of carbamazepine must be readjusted. A common drug-drug interaction is between carbamazepine and the macrolide antibiotics erythromycin and trolean-domycin. After a few days of antibiotic therapy, symptoms of carbamazepine toxicity develop this is readily reversible if either the antibiotic or carbamazepine is discontinued. 

Although all of the benzodiazepines are similar, certain ones are employed more for the treatment of seizure disorders. Clonazepam was the first benzodiazepine approved in the United States specihcally for the treatment of convulsive disorders. Clonazepam is a very long acting compound with potent anticonvulsant activity. Unfortunately, sedation and tolerance tend to hmit its usefulness. Drooling and hypersalivation may be troublesome in children and in infants. 

A long half-life is needed for a BZ to be effective as an anticonvulsant to avoid a withdrawal effect. Clonazepam, nitrazepam, and nordazepam are the BZs most often used for their anticonvulsant effects, al-... 

More recently, gabapentin has been added to the arsenal of medications used for the treatment of chronic pain, along with other anticonvulsant drugs, such as carbamazepine and clonazepam, as used in the treatment of neuropathies in children (Berde et ah, 1993 Green and Kowalik 1994). 

Benzodiazepines are highly effective anxiolytics and sedatives. They also have muscle relaxant, amnestic, and anticonvulsant properties. Benzodiazepines effectively treat both acute and chronic generalized anxiety and panic disorder. The high-potency benzodiazepines alprazolam and clonazepam have received more attention as antipanic agents, but double-blind studies also have confirmed the efficacy of diazepam and lorazepam in the treatment of panic disorder. Although only a few benzodiazepines are specifically approved by the... 

Nevertheless, the GABAergic properties of benzodiazepines remain their most important clinical application. Over the past 30 years, the most widely used benzodiazepine drug has been diazepam (1.6). It is an anxiolytic, sedative, and muscle relaxant the anxious, depressed person becomes more outgoing and relaxed. There have been many diazepam analogs. Oxazepam (4.177) and lorazepam (4.178) have similar effects. Temazepam (4.179), flunitrazepam (4.180), and flurazepam (4.181) are useful sedative-hypnotics. Clonazepam (4.182) is a clinically useful anticonvulsant. Brotizolam (4.183), a novel benzodiazepine analog, seems to be an effective sedative-hypnotic. Midazolam (4.184) is an imidazolo-benzodiazepine that is water soluble and thus easily injectable. It is a hypnotic sedative with marked amnestic (i.e., memory loss) properties and is used in dentistry, endoscopic procedures, and induction to anesthetics in the elderly and in... 

Klonopin 8 Clonazepam 1-6 Panic disorder, anticonvulsant, alcohol withdrawal, social phobia, acute mania... 

Typical doses of clonazepam have been in the range of 2 to 16 mg/day given on a once or twice per day schedule due to its longer half-life. A major advantage of this anticonvulsant is its relative lack of adverse effects and freedom from laboratory monitoring in comparison with CBZ and VPA. Clonazepam may be more useful when combined with lithium or CBZ rather than as a specific antimanic agent, perhaps supplanting the need for antipsychotics. In this sense, it can be viewed as a behavioral suppressor, rather than a true mood stabilizer (121). 

Halman et al. (491) conducted a retrospective chart review on 11 patients who were HIV-positive and presented with an acute manic episode. Whereas the six patients with abnormal MRI findings demonstrated intolerance to standard drug treatment (i.e., lithium, conventional neuroleptics), all benefited from a trial with an anticonvulsant (e.g., valproate, CBZ, clonazepam). 

Benzodiazepines exert central depressant effects on spinal reflexes, in part mediated by the brainstem reticular system.3 For example, chlordiazepoxide depresses the duration of electrical after-discharge in the limbic system. Most benzodiazepines elevate the seizure threshold and therefore may be used as anticonvulsant medications. Diazepam, clonazepam, and clorazepate may be prescribed for this therapeutic purpose. 

Benzodiazepines. Benzodiazepines have anticonvulsant actions, especially intravenous diazepam and oral clonazepam. They are also sedating. Both of these actions have led to the use of benzodiazepines for the treatment of mood disorders, especially as adjunctive treatment for agitation and psychotic behavior during the phase of acute mania. Benzodiazepines are also broadly used in anxiety and sleep disorders. 

Diazepam [459-14-5] (60) and clonazepam [1622-61-5] (61) suppress cough induced by electrical stimulation of the lower brainstem of cats (90). Clonazepam and diazepam administered intravenously are about thirty-five times and six times more potent than codeine, respectively. Nevertheless, the compounds have not been widely used as antitussives in humans. Diazepam is used in the treatment of anxiety, and clonazepam as an anticonvulsant. 

Clonazepam (Klonopin), a benzodiazepine anticonvulsant, has been useful in a limited number of patients, but controlled studies comparing this drug with carbamazepine and baclofen have never been performed. 

Hallucinogen persisting perception disorder is commonly called the flashback. While flashbacks are brief, usually lasting only a few seconds, these experiences often cause considerable anxiety and distress, due to the sudden, unanticipated onset of the episodes and the inability of the sufferer to control their occurrence. Psychotherapy is often sufficient treatment for anxiety and distress associated with flashbacks. Occasionally treatment with a long-acting tranquilizer, such as clonazepam, may be required. Anticonvulsant drugs, such as valproic acid and carbamazepine, have also been used to control flashbacks. However, antipsychotic drugs have been reported to exacerbate flashbacks and should not be prescribed. 

Most of the sedative-hypnotics are capable of inhibiting the development and spread of epileptiform activity in the central nervous system. Some selectivity exists in that some members of the group can exert anticonvulsant effects without marked central nervous system depression (although psychomotor function may be impaired). Several benzodiazepines—including clonazepam, nitrazepam, lorazepam, and diazepam—are sufficiently selective to be clinically useful in the management of seizure states (see Chapter 24 Antiseizure Drugs). Of the barbiturates, phenobarbital and metharbital (converted to phenobarbital in the body) are effective in the treatment of generalized tonic-clonic seizures. 

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