Drowsiness clonazepam

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. 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

In controlled trials with clonazepam, adverse events were recorded in 60-90% of cases, and led to withdrawal rates as high as 36% (8). The most common effects were drowsiness, ataxia, and behavioral and personality changes. Other problems were hypersalivation, tolerance, and sometimes a paradoxical increase in seizure frequency. 

Clonazepam is a benzodiazepine that is used predominantly in epilepsy, panic disorder, and mania, and also appears to be effective in relieving antipsychotic drug-induced akathisia (1). The use of clonazepam in psychiatric disorders is complicated by significant drowsiness in a majority of patients, and additional behavioral problems in children (SEDA-19, 34). 

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. 

Clonazepam, proprietary name Clonopin, is a benzodiazepine with chemical structure closely related to diazepam. The mechanism of action is the same as described for diazepam, but tolerance does not develop as rapidly as with diazepam. Clonazepam is currently approved for use in absence seizures, infantile spasms, akinetic seizures, and Lennox-Gastaut syndrome. Plasma concentrations associated with maximal effectiveness of the drug range from 15 to 60 ng/mL. At concentrations higher than 80 ng/mL, no additional seizure protection is observed, and toxicity (drowsiness and ataxia) ensues. The most suitable methods adaptable to routine analysis are based on GLC with electron capture detection, although HPLC methods also are effective. ... 

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). 

Clonazepam (1.5 mg/day in three divided doses) is used alone or as adjunctive treatment of Lennox-Gastaut syndrome (petit mal variance) and akinetic and myoclonic seizures. It may be used in patients with petit mal (absence) seizures who have failed to respond to succinamides. Clonazepam is actually a broad-spectrum anticonvulsant because it is also effective in tonic-clonic (grand mal) and complex partial (psychomotor-temporal lobe) seizures. Clonazepam causes drowsiness (increased by barbiturate administration) and a dose-dependent ataxia, hi addition, behavioral abnormahties such as hypersensitivity, irritability, and aggression may occur, but these are mostly seen in children (see also Figure 50). 

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. 

Clonazepam is well absorbed, 95 to 98% protein bound, and extensively metabolized by CYP3A4. Clonazepam displays a wide spectrum of antiseizure activities and is one of the most potent AEDs. Side effects are common, however, and the development of tolerance is more frequent than with ethosuximide or valproate. Sedation is prominent, especially early in treatment. Drowsiness, ataxia, and behavioral changes may be disabling, but slowly Increasing its dose over a 2-week period Is recommended to minimize adverse effects. Diplopia, headaches, nystagmus, and other neurologic effects have been reported with the use of clonazepam. 

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. ... 

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%. ... 

There seems to be only one report (with temazepam) of a olinieally signif-ieant interaction between disiifiram and the benzodiazepines, and this report is unconfirmed, as the patient did not take temazepam alone. The other reports only describe potential interactions that have been identified by single-dose studies. These do not necessarily reliably predict what will happen in practice. However, it seems possible that some patients will experience increased drowsiness, possibly because of this interaction, and because drowsiness is a very common adverse effect of disulfiram. Reduce the dosage of the benzodiazepine if necessary. Benzodiazepines that are metabolised by similar pathways to diazepam and chlordiazepoxide, may possibly interact in the same way (e.g. bromazepam, clonazepam, clorazepate, prazepam, ketazolam, clobazam, flurazepam, nitrazepam, medazepam) but this needs confirmation. Alprazolam, oxazepam and lo-razepam appear to be non-interacting alternatives. 

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