Clonazepam dosing

A patient who had been taking phenelzine 45 mg daily for 9 years developed a severe occipital headache after taking 500 micrograms of clonazepam. A similar but milder headache occurred the next night when she took the same dose. No blood pressure measurements were taken. Another report describes facial flushing in a patient taking clonazepam, which occurred after phenelzine was started, and which responded to a reduction in the clonazepam dose. ... 

As with the barbiturates, the most common adverse reaction seen with the use of clonazepam (Klonopin), clorazepate (Tranxene), and diazepam (Valium) is sedation in varying degrees. Additional adverse effects may include anorexia, constipation, or diarrhea. Some adverse reactions are dose dependent, whereas others may diminish in intensity or cause few problems after several weeks of therapy. 

Non-REM parasomnias usually do not require treatment. If needed, low-dose benzodiazepines such as clonazepam can be prescribed for bothersome episodes. Clonazepam reduces the amount of sleep time spent in stages 3 and 4 of non-REM sleep, where most non-REM parasomnias occur. For treating RBD, clonazepam 0.5 to 2 mg at bedtime is the drug of choice, although melatonin 3 to 12 mg at bedtime also may be effective. Patients with RBD also should have dangerous objects removed from the bedroom and cushions placed on the floor to reduce the chance of injury from breakthrough episodes. 

Alprazolam and clonazepam are the most frequently used of the BZs and are well accepted by patients. Therapeutic response typically occurs in 1 to 2 weeks. With alprazolam, the duration of action may be as little as 4 to 6 hours with breakthrough symptoms between dosing. The use of extended-release alprazolam or clonazepam avoids this problem. 

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. 

Benzodiazepines are preferred by many for the management of agitation in nonpsychotic bipolar patients, though antipsychotics are effective as well. The most widely used benzodiazepines for this purpose are lorazepam and clonazepam. Lorazepam is perhaps the most versatile of the benzodiazepines. It has an intermediate duration of action, does not tend to accumulate and thereby cause confusion or excessive drowsiness, and can be administered by mouth, intramuscular injection, or intravenous injection. Lorazepam should be administered on an as-needed basis several times daily at 0.5-2mg per dose. The calming effects of lorazepam are usually evident within 20-30 minutes and will last for several hours. 

By contrast, clonazepam is an especially long-acting benzodiazepine that is only available in an oral preparation. Clonazepam can be started at 0.5-1 mg/day given in one or two doses per day. Whereas lorazepam provides a relatively quick onset of its tranquilizing effects, clonazepam offers a calming effect that lasts throughout the day. 

Benzodiazepines. The introduction of the benzodiazepines represented a significant advance in the treatment of panic disorder. In contrast to MAOIs and TCAs, the benzodiazepines begin to provide relief the very first day of treatment, and many patients experience a complete response by the end of the second week of therapy. All benzodiazepines should theoretically alleviate the symptoms of a panic attack at comparable doses, but the benzodiazepines of choice are alprazolam (Xanax, Xanax XR) and clonazepam (Klonopin). It likely is not coincidental that these two are among the highest potency benzodiazepines. However, they differ considerably from a pharmacokinetic standpoint. If clonazepam is the tortoise of benzodiazepines, then alprazolam is the hare. 

When initiating benzodiazepine treatment for GAD, tolerability can be improved by starting at a low dose and gradually titrating to the effective dose range over the course of several days. Most patients with GAD respond well to l-3mg/day of extended-release alprazolam, l-2mg/day of clonazepam, or 10-20mg/day of diazepam. Elderly patients often do best at approximately half these daily doses. 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

Benzodiazepines. The best studied of the benzodiazepines for social anxiety disorder, clonazepam has been demonstrated in controlled trials to be effective during both acute treatment (at an average dose of 2.4mg/day) and long-term maintenance therapy lasting up to 2 years. A controlled study of another high potency benzodiazepine, alprazolam, also proved effective, though it was outperformed by the MAOI antidepressant phenelzine and exhibited response rates lower than those reported with clonazepam. 

Benzodiazepines offer several advantages over alternative treatments. They act quickly, can be dose-adjusted in an expeditious manner, and can be administered both in scheduled doses and on an as-needed basis. Despite their rapid action, however, one controlled study of clonazepam showed that some patients did not experience a satisfactory treatment response for 6-8 weeks. One important... 

Clonazepam should initially be administered at 0.25-1 mg/day and titrated every 3-7 days to an effective dose of 0.5-4 mg/day in one to two daily doses. Shorter-acting alprazolam is initiated at 0.5-1 mg/day in two to four divided daily doses and titrated to 1-8 mg/day in two to four divided daily doses. The extended release formulation of alprazolam permits less frequent dose administration. Initiating the benzodiazepines at a low dose and titrating in a stepwise fashion minimizes the potential for excessive sedation during treatment initiation. 

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. 

Ultimately, it is a drug s half-life combined with its potency that dictates its utility as a sedative-hypnotic. Like other benzodiazepines, clonazepam (Klonopin) can be used to treat insomnia, but its long duration of action renders it prone to hangover effects at doses needed to treat insomnia. Nevertheless, low doses of clonazepam (0.25-2 mg) are a treatment for PLMD and are also used to treat RLS. When hangover effects of even low doses of clonazepam are a problem, other benzodiazepines can be used. 

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. 

For the treatment of panic disorder, the starting adult dose is 0.25 mg twice a day, which may be increased by one mg daily after three days. Clonazepam s safety and effectiveness has not been determined for individuals under the age of 18. Side effects in the treatment of panic disorders are similar to many of the benzodiazepines, and include allergic reaction, inflamed sinuses or nasal passages, flu, menstrual problems, respiratory infection, speech problems, and vaginal inflammation. 

The initial study of clonazepam in social phobia conducted by Versiani et al. [1989] showed an overall benefit of the drug. This 8-week, open trial of 40 subjects displayed statistically significant lowering of scores on the efficacy variables, which included the Clinical Global Improvement and Severity Scales [Guy 1976], Liebowitz Social Anxiety Scale [liebowitz 1987], Hamilton Anxiety Scale [M. Hamilton 1959], and the Sheehan Disability Scale [D. V. Sheehan 1986]. The mean dose of clonazepam was 3.9 mg/day [SD 0.5 mg]. Subjects in this study reported high rates of side effects, including sleepiness [67.5%], loss of libido [67.5%], and memory problems [35%]. 

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