Clonazepam drug interactions

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. 

Bonate PL, Kroboth PD, Smith RB, Suarez E, Oo C. Clonazepam and sertraline absence of drug interaction in a multiple-dose study. J Clin Psychopharmacol 2000 20(1) 19-27. 

Burrows DL, Hagardorn AN, Harlan GC, Wallen ED, Ferslew KE. A fatal drug interaction between oxycodone and clonazepam. J Forensic Sci 2003 48(3) 683-6. 

A fatal drug interaction was caused by the ingestion of oxycodone and clonazepam. 

Windorfer A, Sauer W. Drug interactions during anticonvulsant Iher y in childhood diphe-nylhydantoin, primidone, phenobarbitone, clonazepam, nitrazepam, carbamazepin and dipro-pylacetate. Neuropadiatrie (1977) 8, 29-41. 

The addition of risperidone 10 mg/day over 2 months to valproate and clonazepam in a 40-year-old woman provoked marked edema in the legs and moderate edema in the arms (276). The authors considered that this was a possible interaction, since edema has not been reported with either of these drugs separately. 

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). 

The addition of piracetam (2 to 4 g three times daily, increased to a maximum of 18 to 24 g daily) did not affect plasma levels of sodium valproate or primidone in patients with myoclonus. The exact number of patients taking these drugs is unelear, sinee the report just states that 28 patients were taking clonazepam, sodium valproate, or primidone, alone or in combination. Another similar report, briefly noted the same finding. The manufacturer notes that, although based on a small number of patients, no interaction has been found between piracetam and clonazepam, carbamazepine, phenytoin, phenobarbital and sodium valproate. No special precautions appear to be required if piracetam is used with these antiepileptics. 

None of the interactions between the benzodiazepines and antiepileptics described here appear to be of major clinical importance, with the possible exception of the interaction between clobazam and felbamate. If both drugs are given be aware that additive sedative or other adverse effects may occur. This may also be possible in some rare cases with chlordiazepoxide or clobazam and phenobarbital clonazepam and lamotrigine or primidone and clorazepate and primidone. 

Saavedra IN, Aguilera LI, FaureE, GaldamesDG. Case report. Phenytoin/clonazepam interaction, Ther Drug Monit (19S5) 7, 481-4. 

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