Clonazepam - instructions for use, reviews, analogs and formulations (tablets 0.5 mg and 2 mg) of the drug for the treatment of epilepsy, seizures and seizures in adults, children and pregnancy. Composition and interaction with alcohol, withdrawal syndrome

In this article, you can read the instructions for using the drug Clonazepam. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Clonazepam in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. The withdrawal syndrome, after the end of the drug. Analogues of clonazepam in the presence of existing structural analogues.Use for the treatment of epilepsy, seizures and seizures in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Clonazepam antiepileptic agent from the benzodiazepine group. Has pronounced anticonvulsant, as well as central miorelaksiruyuschee, anxiolytic, sedative and hypnotic action.

Increases the inhibitory effect of GABA on the transmission of nerve impulses. Stimulates benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of the brainstem and intercalary neurons of the lateral horns of the spinal cord. Reduces the excitability of subcortical structures of the brain (limbic system, thalamus, hypothalamus), inhibits postsynaptic spinal reflexes.

Anxiolytic effect is due to the influence on the amygdala complex of the limbic system and is manifested in a decrease in emotional tension, easing anxiety, fear, anxiety.

The sedative effect is due to the effect on the reticular formation of the brainstem and the nonspecific nuclei of the thalamus and is manifested by a decrease in neurotic symptoms(anxiety, fear).

Anticonvulsant action is realized due to increased presynaptic inhibition. This suppresses the spread of epileptogenic activity that occurs in epileptogenic foci in the cortex, thalamus, and limbic structures, but the excited state of the focus is not removed.

It is shown that in a human clonazepam rapidly suppresses paroxysmal activity of various types, incl. complexes "spike-wave" with absences (petit mal), slow and generalized complexes "spike-wave", "soldering" of temporal and other localization, as well as irregular "spikes" and waves.

Changes in the generalized EEG are suppressed more than focal. In accordance with these data, clonazepam has a beneficial effect in the generalized and focal forms of epilepsy.

Central miorelaksiruyuschee effect due to inhibition of the polysynaptic spinal afferent inhibitory pathways (to a lesser extent, monosynaptic). Perhaps a direct inhibition of the motor nerves and muscle functions.

Composition

Clonazepam + auxiliary substances.

Pharmacokinetics

When administered, bioavailability is more than 90%. Binding to plasma proteins - more than 80%.It is excreted mainly in the form of metabolites.

Indications

• epilepsy (adults, infants and young children): typical absences (petit mal), atypical absences (Lennox-Gastaut syndrome), cramping seizures, atonic seizures (fall syndrome or drop-attacks);
• infantile spasms (Vest syndrome);
• tonic-clonic convulsions (grand mal), simple and complex partial seizures and secondary generalized tonic-clonic convulsions;
• status epilepticus (intravenous administration);
• somnambulism;
• muscular hypertonia;
• insomnia (especially in patients with organic brain lesions);
• psychomotor agitation;
• alcohol withdrawal syndrome (acute agitation, tremor, threatening or acute alcohol delirium and hallucinations);
• panic disorder.

Forms of release

Tablets 0.5 mg and 2 mg.

Instructions for use and dosage

Individual. For oral administration, an initial dose of no more than 1 mg per day is recommended. The maintenance dose is 4-8 mg per day.

For infants and children aged 1-5 years, the initial dose should not be more than 250 μg per day, for children aged 5-12 years - 500 μg per day.Supporting daily doses for children under 1 year of age - 0.5-1 mg, 1-5 years - 1-3 mg, 5-12 years - 3-6 mg.

For elderly patients, an initial dose of not more than 500 μg is recommended.

The daily dose should be divided into 3-4 equal doses. Supportive doses are prescribed after 2-3 weeks of treatment.

Intravenous (slow) adults - 1 mg, children under 12 years - 500 mcg.

Side effect

• pronounced inhibition;
• feeling tired;
• drowsiness;
• lethargy;
• dizziness;
• a state of stupor;
• headache;
• confusion of consciousness;
• nystagmus;
• paradoxical reactions (including acute excitation conditions);
• anterograde amnesia;
• muscle weakness;
• depression;
• dry mouth;
• nausea, vomiting;
• heartburn;
• decreased appetite;
• constipation or diarrhea;
• increased salivation;
• a decrease in blood pressure;
• tachycardia;
• change in libido;
• dysmenorrhea;
• reversible premature sexual development in children (incomplete premature puberty);
• with intravenous administration, respiratory depression is possible, especially when treated with other drugs that cause respiratory depression;
• in infants and young children, bronchial hypersecretion is possible;
• leukopenia, neutropenia, agranulocytosis, anemia, thrombocytopenia;
• urinary incontinence;
• retention of urine;
• impaired renal function;
• hives;
• skin rash;
• itching;
• anaphylactic shock;
• transient alopecia;
• change in pigmentation;
• addictive;
• withdrawal syndrome.

Contraindications

• depression of the respiratory center;
• severe COPD (progression of the degree of respiratory failure);
• acute respiratory failure;
• myasthenia gravis;
• coma;
• shock;
• closed angle glaucoma (acute attack or predisposition);
• acute alcohol intoxication with impaired vital functions;
• acute poisoning with narcotic analgesics and hypnotics;
• severe depression (suicidal tendencies may occur);
• pregnancy;
• lactation period;
• increased sensitivity to clonazepam.

Application in pregnancy and lactation

Contraindicated in pregnancy and lactation. Clonazepam penetrates the placental barrier. Clonazepam may be excreted in breast milk.

Application in elderly patients

With caution apply in elderly patients, tk.they can be slowed withdrawal of clonazepam and reduced tolerance, especially in the presence of cardiopulmonary insufficiency.

Use in children

With prolonged use of clonazepam in children, one should keep in mind the possibility of side effects on physical and mental development, which may not manifest itself for many years.

special instructions

With extreme caution apply in patients with ataxia, severe liver disease, severe chronic respiratory failure, especially in the acute deterioration phase, with episodes of nocturnal apnea.

With caution apply in elderly patients, tk. they can be slowed withdrawal of clonazepam and reduced tolerance, especially in the presence of cardiopulmonary insufficiency.

With prolonged use, it is possible to develop drug dependence. With the abrupt withdrawal of clonazepam after prolonged treatment, the development of the withdrawal syndrome is possible.

It is released by prescription.

With prolonged use of clonazepam in children, one should keep in mind the possibility of side effects on physical and mental development, which may not manifest itself for many years.

During the treatment period, do not drink alcohol.

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, the speed of psychomotor reactions slows down. This should be taken into account by persons engaged in potentially hazardous activities requiring increased attention and speed of psychomotor reactions.

Drug Interactions

When used simultaneously with drugs that exert a depressing effect on the central nervous system, ethanol (alcohol), ethanol-containing drugs may increase the inhibitory effect on the central nervous system.

With the simultaneous use of clonazepam enhances the effect of muscle relaxants; with valproate sodium - the weakening of sodium valproate and the provocation of convulsive seizures.

With simultaneous application, the case of decreasing the concentration of desipramine in the blood plasma was 2 times and its increase after the withdrawal of clonazepam.

With simultaneous use with carbamazepine, which causes the induction of microsomal liver enzymes, it is possible to increase metabolism and as a result, a decrease in the concentration of clonazepam in the blood plasma, a decrease in its T1 / 2.

With simultaneous application with caffeine, a decrease in the sedative and anxiolytic effect of clonazepam is possible; with lamotrigine - a decrease in the concentration of clonazepam in the blood plasma; with lithium carbonate - the development of neurotoxicity.

With simultaneous application with the primidon, the concentration of primidone in the blood plasma increases; with tiapridom - the development of the NSA is possible.

A case of development of a headache with localization in the occipital region is described with simultaneous application with phenelzine.

With simultaneous use, an increase in the concentration of phenytoin in the blood plasma and the development of toxic reactions, a decrease in its concentration or the absence of these changes is possible.

With simultaneous use with cimetidine, side effects from the CNS are increased, however, the frequency of convulsive seizures in some patients decreased.

Analogues of the drug Clonazepam

Structural analogs for the active substance:

• Clonotril;
• Rivotril.

Analogues on the pharmacological group (anxiolytics):

• Adaptol;
• Alzolam;
• Alprazolam;
• Alprox;
• Anvifen;
• Apaurin;
• Atarax;
• Afobazol;
• Bromide;
• Valium Rosh;
• Hydroxysine;
• Grandaxin;
• Diazepam;
• Diazepec;
• Diapam;
• Zolomax;
• Ipronal;
• Kassadan;
• Xanax;
• Xanax retard;
• Lexotan;
• Librax;
• Loram;
• Laurafen;
• Mebicar;
• Mebiks;
• Mexiprim;
• Mexicin;
• Napoton;
• Neurol;
• Nozepam;
• Noophen;
• Relanium;
• Relium;
• Seduxen;
• Sibazon;
• Tazepam;
• Tenoten;
• Tenoten for children;
• Tofizopam;
• Tranxen;
• Phenazepam;
• Fenibut;
• Helex;
• Elenium;
• Elzepam.

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