Clonazepam with valproic acid

Myoclonic syndromes Myoclonic seizure syndromes are usually treated with valproic acid. Clonazepam can be effective, but the high doses required cause drowsiness. Lamotrigine is also reported to be effective in myoclonic syndromes in children. Felbamate has been used adjunctively with the primary drugs but has hematotoxic and hepatotoxic potential. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

Hallucinogen persisting perception disorder is commonly called the flashback. While flashbacks are brief, usually lasting only a few seconds, these experiences often cause considerable anxiety and distress, due to the sudden, unanticipated onset of the episodes and the inability of the sufferer to control their occurrence. Psychotherapy is often sufficient treatment for anxiety and distress associated with flashbacks. Occasionally treatment with a long-acting tranquilizer, such as clonazepam, may be required. Anticonvulsant drugs, such as valproic acid and carbamazepine, have also been used to control flashbacks. However, antipsychotic drugs have been reported to exacerbate flashbacks and should not be prescribed. 

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... 

In patients with brain-stem reticular-reflex myoclonus, valproic acid and clonazepam are the most useful agents. In hyperreflexia, treatment is directed against the disabling tonic spasms, rather than jerks. Carbamazepine, phenytoin, and clonazepam are useful agents in this respect. Ballistic overflow myoclonus may improve with anticholinergic drugs such as benztropine or trihexyphenidyl. 

Three of the drugs listed are effective in absence seizures. Ethosuximide and valproic acid are not sedating, and tolerance does not develop to their antiseizure activity. Clonazepam is effective but exerts troublesome CNS depressant effects, and tolerance develops with chronic use. At high doses, the drug has a dependence liability like most benzodiazepines. The answer is (A). 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

A number of compounds bearing different miscellaneous basic chemical structures have been found to possess significant anticonvulsant properties. A few such compounds are dealt with in this section, namely Primidione, Phenacemide, Carbamazepine, Sultiame, Valproic acid, Clonazepam. A. Primidone INN, BAN, USAN,... 

In 12 adults with status epilepticus, intravenous levetiracetam 2500 mg was added as soon as possible to a standardized regimen of intravenous clonazepam and/or rectal diazepam as needed followed by phenytoin or valproic acid no serious adverse effects could be related directly to the administration of levetiracetam [208 ]. 

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