Clonazepam

Information about Clonazepam

Clonazepam is a benzodiazepine used predominantly as an anticonvulsant as adjunctive therapy in management of epilepsy. 

Liver safety of Clonazepam

Therapy with clonazepam is not associated with serum aminotransferase elevations, and clinically apparent liver injury from clonazepam, if it occurs at all, must be exceedingly rare.

Mechanism of action of Clonazepam

Clonazepam (kloe naz' e pam) is a benzodiazepine with particularly potent activity against spread of seizure activity in several animal models.  The antiseizure activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA A receptor. 

FDA approval information for Clonazepam

Clonazepam was approved in the United States for treatment of epilepsy in 1997 and currently more than 20 million prescriptions are filled yearly. 

Clinical use of Clonazepam

Clonazepam is currently indicated for management of absence seizures and myoclonic seizures in children as well as generalized seizure disorders in both adults and children.  Clonazepam is effective in status epilepticus, but diazepam and lorazepam are preferable because of their longer half lives.  Clonazepam is also used for restless leg syndrome, dysarthria, tic disorders, panic disorder and acute mania. 

Dosage and administration for Clonazepam

Clonazepam is available in generic forms and under the brand name Klonopin in tablets of 0.5, 1.0 and 2 mg as well as in orally disintegrating tablets for pediatric use.  The recommended initial dose for adults is 1.5 mg daily in three divided doses, increasing as needed to a maximum dose of 20 mg daily. 

Side effects of Clonazepam

The most common side effects of clonazepam are dose related and include drowsiness, lethargy, ataxia, dysarthria and dizziness.  Tolerance develops to these side effects, but tolerance may also develop to the antiseizure effects. Anticonvulsants

Generic Name / Brand Name	Liver Toxicity Score	Approval Year	Major Indications
Brivaracetam / Briviact	E	2016	Partial seizures
Carbamazepine / Tegretol	A	1968	Partial, mixed and generalized seizures, trigeminal neuralgia
Clobazam / Onfi	E	2011	Seizures assocated with Lennox-Gastaut syndrome
Clonazepam / Klonopin	D	1975	Absence and myoclonic seizures, anxiety and panic disorders
Clorazepate / Tranxene	E	1972	Partial seizures, anxiety disorders, and alcohol withdrawal
Diazepam / Valium	E	1963	Convulsions, anxiety disorders, muscle spasms
Eslicarbazepine / Aptiom	D	2013	Partial seizures
Ethosuximide / Zarontin	E	1960	Absence seizures
Ezogabine / Potiga	E	2011	Partial seizures
Felbamate / Febatol	B	1993	Refractory or severe epilepsy
Fosphenytoin / Cerebyx	A	1996	Tonic-clonic seizures, status epilepticus
Gabapentin / Neurontin	C	1993	Partial seizures, post-herpetic neuralgia
Lacosamide / Vimpat	D	2008	Partial seizures
Lamotrigine / Lamictal	B	1994	Partial and generalized tonic-clonic seizures, bipolar disorder
Levetiracetam / Keppra	C	1999	Partial, generalized tonic-clonic, and myoclonic seizures
Methsuximide / Celontin	E	1957	Absence seizures
Oxcarbazepine / Trileptal	D	2000	Partial seziures
Perampanel / Fycompa	E	2012	Partial and generalized tonic-clonic seizures
Phenobarbital / Luminal	A	1916	Partial and generalized seizures, anxiety, and irritable bowel syndrome
Phenytoin / Dilantin	A	1938	Generalized tonic-clonic and partial onset seizures, status epilepticus
Pregabalin / Lyrica	C	2004	Partial seizures, fibromyalgia, and neuropathic pain
Primidone / Mysoline	E	1954	Partial and generalized tonic-clonic seizures
Rufinamide / Banzel	E	2008	Seizures associated with Lennox-Gastaut syndrome
Tiagabine / Gabitril	E	1997	Partial seizures
Topiramate / Topamax	C	1996	Partial and generalized tonic-clonic seizures, migraine headaches
Valproate / Depakene	A	1978	Absence and complex partial seizures
Vigabatrin / Sabril	D	2009	Refractory, complex partial seizures, and infantile spasms
Zonisamide / Zonegran	D	2000	Partial seizures

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