Stahl's Essential Psychopharmacology Online
In Collaboration With
Clonazepam
Therapeutics
Brands
• Klonopin, Rivotril
Generic?
Yes
Class
• Benzodiazepine, antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Seizure disorders. Used as monotherapy or adjunctive for the treatment of Lennox-Gastaut syndrome, akinetic, myoclonic or
absence seizures
• Panic disorder, with or without agoraphobia
• Periodic leg movements disorder (PLMD)
• Restless legs syndrome (RLS)
• Tic disorders
• Parkinsonian (hypokinetic) dysarthria
• Muscle relaxation
• Insomnia
• Burning mouth syndrome
• Generalized anxiety disorder
• Schizophrenia (adjunctive)
• Acute mania in bipolar disorder
How the Drug Works
• Benzodiazepines
bind to and potentiate the effect of GABA-A receptors, boosting
chloride conductance through GABA-regulated
channels, and other inhibitory
neurotransmitters. There are at least 2 benzodiazepine receptors, 1 of
which is associated
with sleep mechanisms, the other
with memory, sensory and cognitive functions. They act at spinal cord,
brainstem, cerebellum,
limbic and cortical areas
• In petit mal seizures clonazepam suppresses spike and wave discharges, and in motor seizures decreases the frequency, amplitude,
duration and spread of discharge
How Long Until It Works
• There is often an immediate effect in treatment of epilepsy, PLMD, RLS, insomnia and panic disorders, but usually weeks are
required for optimal dose adjustments and maximal therapeutic benefit
If It Works
• Seizures - goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly
stopping after 2 years seizure-free, depending on the type of epilepsy
• PLMD, RLS, tic disorders - continue to adjust dose to find the lowest dose that produces relief of symptoms with fewest AEs
• Anxiety - often used only on a short-term basis. Consider adding an SSRI or SNRI for long-term treatment
If It Doesn't Work
• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation
• PLMD,
RLS: change to or use combination with a dopamine agonist or an AED
such as gabapentin or carbamazepine. Rule out iron-deficiency;
if obese, weight loss may be helpful
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Epilepsy: often used in combination with other AEDs for optimal control but sedation can increase
• PLMD, RLS: dopamine agonists or gabapentin
• Anxiety: SSRI or SNRIs. In most cases it is best to avoid combining with other benzodiazepines
• Insomnia: may be combined with low-dose tricylic antidepressants (amitriptyline), or tetracyclics (trazodone, mirtazapine)
Tests
• None required