Clonazepam Sodium valproate

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. 

Support is scant for the efficacy of anticonvulsant agents in the treatment of OCD (Jenike 1990 Joffe and Swinson 1987). If there is a role for carbamazepine in OCD, it may be in patients with clinical or electroen-cephalographic evidence of a seizure disorder (Jenike and Brotman 1984 Khanna 1988). The anti-OC efficacy of combined SRI-carbamazepine treatment has not been adequately studied. Sodium valproate was found ineffective in two cases of OCD (McElroy and Pope 1988 McElroy et al. 1987). However, one author has suggested that sodium valproate may be a useful pretreatment for patients with OCD who might otherwise tolerate SRIs poorly (Deltito 1994). The anticonvulsant clonazepam is discussed earlier in this chapter. 

It is a benzodiazepine useful in the treatment of petitmal epilepsy, myoclonic seizures and infantile spasms. It is used in the treatment of petitmal epilepsy not responding to ethosuximide and sodium valproate. Clonazepam and diazepam act by increasing the effectiveness of the inhibitory neurotransmitter GABA, within the central nervous system. 

Ontiveros A, Fontaine R. Sodium valproate and clonazepam for treatment-resistant panic disorder. J Psychiatr Neurosci 1992 17 78-80. 

There is little evidence that lithium is superior to other drugs with sedative actions for the treatment of acute mania. Benzodiazepines, neuroleptics and anticonvulsants have all been tried in mania and none have been found to be inferior to lithium. Two small studies of clonazepam in mania found it was superior to lithium (Chouinard 1988 Chouinard, Young, Annable 1983). All new- and old-generation neuroleptics have been found to be more effective than placebo (Perlis et al. 2006). Comparisons of lithium with the sedative anticonvulsants carbamazepine and sodium valproate show similar effects (Bowden et al. 1994 Freeman et al. 1992 Lerer et al. 1987 Small et al. 1991). 

The effects of concomitant carbamazepine, phenytoin, sodium valproate, and zonisamide on the steady-state serum concentrations of clonazepam have been investigated in 51 epileptic in-patients under 20 years of age (14). Serum concentrations of clonazepam correlated positively with the dose of clonazepam and negatively with the doses of carbamazepine and valproic acid, but not with phenytoin or zonisamide. These results confirm that as the oral doses of carbamazepine and sodium valproate increase, the serum concentration of clonazepam falls, but there is no interaction with either phenytoin or zonisamide. In the case of carbamazepine the mechanism of action is thought to be enzyme induction, increasing the metabolism of clonazepam. It is not known what the mechanism is with sodium valproate. In patients with epilepsy, the co-administration of either sodium valproate or carbamazepine will reduce the serum concentration of clonazepam and increase the risk of a seizure. When... 

Individual drugs carbamazepine, phenytoin, sodium valproate, lamotrigine, vigabatrin, gabapentin, clonazepam, topiramate, levetiracetam. 

Anticonvulsants. Carbamazepine, phenobarbital and primidone accelerate warfarin metabolism (enzyme induction) the effect of phenytoin is variable. Clonazepam and sodium valproate are safe. 

Clinically important, potentially hazardous interactions with carbamazepine, clonazepam, phenobarbital, phenytoin, sodium valproate... 

Treatments of first choice for cortical myoclonus are valproic acid (sodium valproate) and clonazepam. Primidone and phenobarbital may also be useful. Piracetam has advantages in these circumstances, as its addition to existing treatments is rarely accompanied by sedation. 

Sodium valproate Methotre)Gite (high dose) Acute lymphoblastic leukaemia A child had a seizure a few hours after methotrexate. Serum valproate levels reduced by 75%. The valproate dose was increased by 50% and clonazepam added. II... 

The serum phenytoin levels of 2 patients rose over a 3-month period when they were given imipramine 75 mg daily. One of them had an increase in phenytoin levels from about 7.6 to 15 micrograms/mL and developed mild toxicity (drowsiness and uncoordination). These signs disappeared and the phenytoin serum levels of both patients fell when the imipramine was withdrawn. One of them was also taking nitrazepam and clonazepam, and the other sodium valproate and carbamazepine, but were stable on these combinations before the addition of imipramine. ... 

Piracetam does not appear to alter the levels of sodium valproate or primidone. No interaction has been found between piracetam and carbamazepine, clonazepam, phenobarbital, or phenytoin. 

The addition of clonazepam to sodium valproate increased the unwanted effects (drowsiness, absence status) in 9 out of 12 paediatric and adolescent patients. An analysis of the clonazepam-valproate interaction in 317 epileptic patients found that concurrent use increased clonazepam clearance by 14% and decreased valproate clearance by 17.9%. ... 

Evidence of an adverse interaetion between valproate and the benzodiazepines and related hypnoties is sparse, and concurrent use is generally beneficial. However, on rare occasions potentially clinically significant effects have been seen. It has been suggested that the combination of clonazepam and sodium valproate should be avoided. However, a very brief letter points out that neither drug affects the serum concentrations of the other and that clonazepam and valproate can be given together in patients with absence seizures since some patients have an excellent response to the combination. ... 

Browne TR. Interaction between clonazepam and sodium valproate. N EnglJ Med (1979) 300, 679. 

The situation with sodium valproate is not entirely clear. There are cases of successful eoneurrent use, but in the light of the reports cited here it would clearly be prudent to monitor concurrent use elosely. A subgroup analysis of 20 patients who reeeived clozapine and earbamazepine, clonazepam, phenobarbital, phenytoin, or valproate suggested that this group of patients showed less elinieal improvement than patients who were not also taking an antiepileptie. However, the indication for the antiepileptic drug was not always clear and eombined treatment may have been used in patients who were more severely ill, or less responsive to clozapine alone. ... 

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