Clonazepam dosage

Clonazepam Klonopin Tablet 0,5, 1,2 mg 0.5-20 mg/day in divided doses or one dose at bedtime. Dosage should be slowly adjusted up and down according to response and adverse effects. 

Like alprazolam, clonazepam may cause treatment-emergent depression in some patients. Pollack et al. (42) also reported that only 10% of their patients who remained on clonazepam had a history of depression, although 47% lost to follow-up and 30% who eventually required alternate treatment had histories of dysthymia or depression. Of 31 patients without a prior history of affective illness, depression developed in three on low daily dosages (0.75, 1.5, and 2 mg), one was switched to alprazolam, and the others responded to the addition of desipramine or imipramine. These investigators recommend that, until further data are available, PD patients with chronic or concurrent depression should not be given clonazepam alone and that those in whom depression develops during clonazepam therapy should have their dose lowered or an adjunctive antidepressant added. 

A 22-year-old African-American with chronic undifferentiated schizophrenia developed priapism after taking risperidone 4 mg bd, clonazepam 0.5 mg bd, vitamin E 400 IU bd, and a multivitamin for over 6 months. He did not respond to subcutaneous terbuta-line 0.25 mg. Irrigation of the corpora with phenylephrine 200 p resulted in detumescence risperidone was withdrawn. A few months later he took ziprasidone 20 mg bd for 1 week, clonazepam 1 mg bd, and vitamin E 400 IU bd. The ziprasidone dosage was increased to 40 mg bd, but early the next morning he developed a firm erection with some discomfort that lasted about 2 hour and resolved when he urinated the next morning he had a similar erection that also lasted 2 hour and resolved. 

Alprazolam and alprazolam XR generally dosed about twice the dosage of clonazepam... 

Clonazepam is generally dosed half the dosage of alprazolam... 

Inhibitors of CYP450 3A4 may affect the clearance of clonazepam, but dosage adjustment usually not necessary... 

Patients taking alprazolam, clonazepam, or imipramine for up to 8 months maintained antipanic efficacy without dosage increases, suggesting that tolerance does not develop to the antipanic effects of these agents. The most important determinant of compliance with... 

Moroz G, Rosenbaun JF. Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder A placebo-controlled, multicenter study using optimized dosages. J Clin Psychiatry 1999 60 604-612. 

THERAPEUTIC USES Clonazepam is useful in the therapy of absence seizures as well as myoclonic seizures in children, but tolerance to its antiseizure effects usually develops within 1-6 months, after which some patients will not respond to clonazepam at any dosage. The initial dose of clonazepam for adults should not exceed 1.5 mg/day and for children 0.01-0.03 mg/kg/day. Dose-dependent side effects are reduced if two or three divided doses are given each day. The dose may be increased every 3 days in amounts of 0.25-0.5 mg/day in children and 0.5-1 mg/day in adults. The maximal recommended dose is 20 mg/day for adults and 0.2 mg/kg/day for children. 

There seems to be only one report (with temazepam) of a olinieally signif-ieant interaction between disiifiram and the benzodiazepines, and this report is unconfirmed, as the patient did not take temazepam alone. The other reports only describe potential interactions that have been identified by single-dose studies. These do not necessarily reliably predict what will happen in practice. However, it seems possible that some patients will experience increased drowsiness, possibly because of this interaction, and because drowsiness is a very common adverse effect of disulfiram. Reduce the dosage of the benzodiazepine if necessary. Benzodiazepines that are metabolised by similar pathways to diazepam and chlordiazepoxide, may possibly interact in the same way (e.g. bromazepam, clonazepam, clorazepate, prazepam, ketazolam, clobazam, flurazepam, nitrazepam, medazepam) but this needs confirmation. Alprazolam, oxazepam and lo-razepam appear to be non-interacting alternatives. 

---