Clonazepam Alcohol

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

High-potency benzodiazepines (e.g., clonazepam and lorazepam) are common alternatives to or in combination with antipsychotics for acute mania, agitation, anxiety, panic, and insomnia or in those who cannot take mood stabilizers. Lorazepam IM may be used for acute agitation. A relative contraindication for long-term benzodiazepines is a history of drug or alcohol abuse or dependency. 

Because Rohypnol is banned in the United States, there is an emerging trend for young people to start abusing two other Rohypnol-like drugs that are still legal in the United States clonazepam (Klonopin ) and alprazolam (Xanax). Both Klonopin and Xanax are benzodiazepines that are used for the treatment of anxiety and insomnia. Although they are less potent than Rohypnol, they can produce similar effects when mixed with alcohol and also have been reported to enhance the effects of heroin. 

Benzodiazepines. Like the barbiturates, benzodiazepines bind to the GABA receptor and are therefore cross-tolerant with alcohol. As a result, they also make suitable replacement medications for alcohol and are widely used for alcohol detoxification. Theoretically, any benzodiazepine can be used to treat alcohol withdrawal. However, short-acting benzodiazepines such as alprazolam (Xanax) are often avoided because breakthrough withdrawal may occur between doses. Intermediate to long-acting benzodiazepines including chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), and clonazepam (Klonopin) are more commonly utilized. 

Drugs that may affect barbiturates include alcohol, charcoal, chloramphenicol, MAO inhibitors, rifampin, and valproic acid. Drugs that may be affected by barbiturates include acetaminophen, anticoagulants, beta blockers, carbamazepine, chloramphenicol, clonazepam, oral contraceptives, corticosteroids, digitoxin, doxorubicin, doxycycline, felodipine, fenoprofen, griseofulvin, hydantoins, methoxyflurane, metronidazole, narcotics, phenmetrazine, phenylbutazone, quinidine, theophylline, and verapamil. 

Most sedative drugs, including narcotics and alcohol, potentiate the sedative effects of benzodiazepines. In addition, medications that inhibit hepatic cytochrome P450 (CYP) 3A3/4 increase blood levels and hence side effects of clonazepam, alprazolam, midazolam, and triazolam. Lorazepam, oxazepam, and temazepam are not dependent on hepatic enzymes for metabolism. Therefore, they are not affected by hepatic disease or the inhibition of hepatic enzymes. 

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

Hammad and Muller (1998) studied the effect of addition of alcohol with different hydrophilicity, such as ethanol, propanol, butanol, pentanol, cyclohexanol, benzyl alcohol as well as 2-phenylethano on clonazepam solubility in MM. Addition of alcohols with ascending lipophilicity beginning with ethanol, propanol, and upto butanol, insigniLcantly affected clonazepam solubility in MM. Addition of pentanol cyclohexanol, benzyl alcohol, or 2-phenylethanol increased the solubility to different degrees. The increase in the lipophilicity of alcohol increased its afLnity to the micellar phase and hence a higher concentration of the alcohol in the micellar phase is expected. 

On the other hand, 2-phenylethanol has a similar chemical structure to benzyl alcohol and hence a similar solubilizing capacity after incorporation in MM. The saturation solubility of 2-phenylethanol in the aqueous 5% MM phase is about 4%, while this is about 5% for benzyl alcohol. From the pharmaceutical point of view, the increase in clonazepam solubility in MM by addition of either benzyl alcohol or 2-phenylethanol makes their usual use as preservatives more advantageous owin< to the possibility of decreasing the concentration of MM. 

RBD is characterized by a relative absence of the atonia characteristic of REM sleep. This lack of atonia permits the physical acting out of dream mentation, particularly dreams involving confrontation, aggression and violence. RBD is seen most frequently in older men. RBD occurs in both acute and chronic forms. Acute RBD can occur during withdrawal from alcohol or sedative-hypnotics. RBD has also been induced by the tricyclics, SSRIs and venlafaxine. The chronic form of RBD may occur as part of an identifiable underlying neurological disorder, but typically is idiopathic. RBD may also be an initial manifestation of parkinsonism. RBD is very responsive to clonazepam, although this use has not been FDA approved. 

Clonazepam Clonazepam interacts with carbamazepine, benzodiazepine, alcohol, and phenytoin. 

Seizures Clonazepam [kloe NA ze pam] is useful in the chronic treatment of epilepsy, whereas diazepam is the drug of choice in terminating grand mal epileptic seizures and status epilepticus (see p. 149). Chlordiazepoxide [klor di az e POX ide], clorazepate [klor AZ e pate], diazepam, and oxazepam [ox A ze pam] are useful in the acute treatment of alcohol withdrawal. 

This fivefold clinical activity is possessed, to a greater or lesser extent, by all benzodiazepines in current clinical use. The properties of benzodiazepines make them ideally useful for managing anxiety (e.g. diazepam, chlordiazepoxide, lorazepam) insomnia (e.g. diazepam, temazepam, nitrazepam, loprazolam, flurazepam, lormetazepam) epilepsy (e.g. clobazam, diazepam, lorazepam) sports injuries where muscle relaxation is required (e.g. diazepam) and as premedications prior to surgery (e.g. midazolam, lorazepam). The benzodiazepines have a number of other uses, including management of alcohol withdrawal syndrome (chlordiazepoxide, diazepam) and restless legs (clonazepam). Short... 

Uses. Benzodiazepines are used for insomnia, anxiety, alcohol withdrawal states, muscle spasm due to a variety of causes, including tetanus and cerebral spasticity, epilepsy (clonazepam, see p. 421), anaesthesia and sedation for endoscopies and cardioversion. 

Essential tremor is often, and with justice, called benign, but a few individuals may be incapacitated by it. Alcohol, through a central action, helps about 50% of patients but is plainly imsuitable for longterm use and a nonselective P-adrenoceptor blocker, e.g. propranolol 120 mg/day, will benefit about 50% clonazepam or primidone are sometimes beneficial. 

Case Conclusion After beginning another rule-out Ml protocol, CV was given an IM injection of lorazepam to acutely control her anxiety and related somatic complaints. She was seen by her primary care provider the next day and ultimately diagnosed with panic disorder and agoraphobia. She was started on daily paroxetine therapy and instructed that she could use clonazepam as needed for extreme anxiety. In addition, she was counseled to diminish the use of alcohol to self-medicate. A referral for psychological counseling was given as well. 

Clinically important, potentially hazardous interactions with alcohol, anticholinergics, barbiturates, benzodiazepines, butabarbital, chloral hydrate, chlordiazepoxide, chlorpromazine, clonazepam, clorazepate, diazepam, ethchlorvynol, fluphenazine, flurazepam, hypnotics, lorazepam, MAO inhibitors, mephobarbital, mesoridazine, midazolam, narcotics, oxazepam, pentobarbital, phenobarbital, phenothiazines, phenylbutazone, primidone, prochlorperazine, promethazine, quazepam, secobarbital, sedatives, temazepam, thioridazine, tranquilizers, trifluoperazine, zolpidem... 

Benzodiazepines are prescribed commonly for SAD. Clonazepam is the most extensively studied benzodiazepine for the treatment of generalized SAD. " Clonazepam improved fear and phobic avoidance, interpersonal sensitivity, fears of negative evaluation, and disability measures. " Adverse effects included sexual dysfunction, unsteadiness, dizziness, and poor concentration. " Clonazepam is often prescribed in conjunction with an antidepressant, psychotherapy, or both for initial symptom relief. Comorbid alcohol or substance abuse are contraindications to the use of benzodiazepines. Other limitations of clonazepam therapy include lack of efficacy in depression and difficulty with discontinuation. Because of the risk of dependency, benzodiazepines should be reserved for patients at a low risk of substance abuse, those who require rapid relief of symptoms, or those who have not responded to other therapies. 

With Klonopin (clonazepam), the most common side effects are difficulty with balance and drowsiness PDR, 2(XX)). Social workers need to be aware that there may be behavioral and emotional side effects that include irritability, excitement, increased anger and aggression, trouble sleeping or nightmares, and memory loss (Dulcan, 1999). These side effects can be very disturbing to the client as well as to family members, and it is critical that families be educated about the problems that can occur and how to handle them. The most serious side effect with Klonopin is probably the interaction if this medication is combined with alcohol or other drugs, which can result in sleepiness, unconsciousness, and death PDR, 2000). 

Puglia, C., Bonina, E, Trapani, G., Franco, M., and Ricci, M. (2001). Evaluation of in vitro percutaneous absorption of lorazepam and clonazepam from hydro-alcoholic gel formulations, Int. J. Pharm., 228 79-87. 

Gabapentin 800 mg on the first day and 600 mg/day on the next 2 days has been prospectively studied in the treatment of acute severe alcohol withdrawal symptoms in 37 patients, of whom 27 were early responders and 10 required treatment with clomethiazole ( = 4) or clonazepam... 

In another case, a 49-year-old woman developed cardiogenic shock after taking 60 disulfiram tablets (15 g), 16 clonazepam tablets (8 mg), and six maprotiline tablets (450 mg) in association with alcohol [53 ]. 

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