Clonazepam side effects

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. 

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. 

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%]. 

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. 

As mentioned in Chapter 2, another side effect of these newer types of antidepressants is that they can cause people to show signs of REM behavior disorder, which is characterized by periodic moments of acting out dreams. Rather than having the person stop taking the antidepressant altogether to avoid this, many times a doctor will prescribe a benzodiazepine such as clonazepam (Klonopin) that helps to suppress the REM behavior disorder symptoms. 

Further disruption of REM sleep is related to the presence of hallucinations and REM sleep behavior disorder in Parkinson s patients. A decrease in REM sleep has been associated with nocturnal hallucinations (125), and REM intrusion during daytime hallucinations has been reported (126). More than one third of Parkinson s patients also suffer from REM sleep behavior disorder (RBD) (127,128) or REM sleep without atonia (128). In these patients, there is also a significant reduction in total sleep time. In many cases RBD is diagnosed several years prior to the onset of Parkinson s disease (129), although a link between disease severity and duration and the presence of RBD has also been reported (128). RBD is most often treated with the administration of clonazepam (104,129). Patients with comorbid dementia and depression also experience a high level of sleep disturbance, associated with nocturnal vocalizations and hallucinations (130). One side effect of many antidepressant medications, however, is insomnia and sleep disturbance (131). 

Side effects. Because clobazam has been widely used as an anxiolytic, its side effects are well known and essentially similar to those of the other benzodiazepines. Thus sedation, dizziness, ataxia, blurred vision and diplopia are the most commonly reported in epileptic patients. One of the most problematic features of clobazam is its tendency to produce tolerance, an effect which may occur more frequently with clobazam than with the other widely used benzodiazepine, clonazepam. It has been estimated that at least 50% of patients develop tolerance. Tolerance to the sedative effects of the drug develop more rapidly than those to the antiepileptic effect. Clobazam should be considered as adjunctive therapy whenever treatment with a single first-line drug has proven to be ineffective. 

Kalachnik JE, Hanzel TE, Sevenich R, Harder SR. Brief report clonazepam behavioral side effects with an individual with mental retardation. J Autism Development Dis 2003 33 349-54. 

For the acute relief of anxiety or panic attacks, benzodiazepines are often useful, usually on an as-needed basis. Many clinicians are reluctant to prescribe these medications for an extended period of time (due to risks associated with physiologic dependence, withdrawal, or abuse), but for the relief of acute symptoms, benzodiazepines are a valuable therapeutic modality. Although a wide variety of benzodiazepines are currently available, they are all qualitatively similar in terms of their pharmacologic effects and side effect potential. Clonazepam and alprazolam are the two benzodiazepines used most commonly to treat anxiety disorders. 

Clonazepam Commonly known as Klonopin. This medication is used to inhibit seizure activity. Side effects can be mild drowsiness, ataxia, and behavioral disturbances that are manifested as aggression, irritability, and agitation. 

In elderly patients refractory to SSRIs, an augmentation strategy with minimal risk is to add buspirone to SSRI therapy. The use of clonazepam should be avoided because of the potential for excess sedation, particularly in frail elderly patients and those with gait disturbances. Because of clomipramine s sedative and anticholinergic side effects, it is not usually chosen as first-line therapy for elderly OCD patients. ... 

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). 

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. 

Absence seizures Ethosuximide and valproic acid are the preferred drugs since they cause minimal sedation. Ethosuximide is often used in uncomplicated absence seizures if patients can tolerate its gastrointestinal side effects. Valproic acid is particularly useful in patients who have concomitant generalized tonic-clonic or myoclonic seizures. Clonazepam is effective as an alternative drug but has the disadvantages of causing sedation and tolerance. 

Clonazepam a benzodiazepine is effective in all types of epilepsy viz., grand mal, psychomotor, petit mal, myoclonic and status epilepticus. However, diazepam another benzodiazepine is preferred in status epilepticus. It possesses minor side effects. 

Clonazepam (Klonopin) was approved in 1975 for monotherapy or adjunctive treatment of akinetic (atonic), myoclonic, and absence variant seizures (64). Clonazepam also was found to be effective in controlling absence seizures, but because of the high incidence of side effects. It Is rated second to ethosuximide. It may be useful, however. In absence seizures when succinimide therapy has failed. It Is considered to be a third-line drug after 1) ethosuximide or valproate and 2) lamotrigine or valproate for the treatment of absence seizures. It is ineffective for treatment of generalized clonic-tonic seizures. 

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