Clonazepam: Difference between revisions
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MDElliottMD (talk | contribs) Comprehensive categorization: +GABAA Positive Allosteric Modulators (General), GABAergics, Anticonvulsants / Antiepileptics |
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Clonazepam | ||
| brand | | brand = Klonopin | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Benzodiazepines|Benzodiazepine]], [[:Category:Anxiolytics|Anxiolytic]], [[:Category:Anticonvulsants|Anticonvulsant]], [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]] | ||
| | | uses = <vote slug="panic-disorder-use">Panic disorder (FDA)</vote>, <vote slug="lennox-gastaut-use">Lennox-Gastaut syndrome (FDA)</vote>, <vote slug="myoclonic-seizures-use">Akinetic and myoclonic seizures (FDA)</vote>, <vote slug="social-anxiety-disorder-use">Social anxiety disorder (off-label)</vote>, <vote slug="rem-sleep-behavior-disorder-use">REM sleep behavior disorder (off-label, evidence-supported)</vote>, <vote slug="restless-legs-syndrome-use">Restless legs syndrome (off-label, second-line)</vote>, <vote slug="acute-mania-adjunct-use">Acute mania adjunct (off-label)</vote> | ||
| uses | | starting_dose = Anxiety: 0.25 mg PO BID, titrate by 0.125-0.25 mg every 3 days to target 1-4 mg/day divided. Seizures: 1.5 mg/day divided TID, titrate by 0.5-1 mg every 3 days | ||
| starting_dose | | preparations = Tablets 0.5, 1, 2 mg; orally disintegrating tablets 0.125, 0.25, 0.5, 1, 2 mg | ||
| preparations | | fda_max = 20 mg/day (seizures); commonly limited to 4 mg/day for anxiety in current practice | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = 20-60 minutes | ||
| duration | | duration = 6-12 hours (long-acting among benzodiazepines) | ||
| halflife | | halflife = 30-40 hours (long; accumulates with chronic dosing)<ref name="klonopin-label">FDA Prescribing Information, Klonopin (clonazepam), Genentech/Roche, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017533s055lbl.pdf</ref> | ||
| bioavailability = ~90% (oral)<ref name="klonopin-label" /> | |||
| pregnancy = Limited human data; some signal for cleft palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.{{citation needed}} | |||
| legal = [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids<ref name="klonopin-label" /> | |||
| | | mechanism = <vote slug="clonazepam-mech-claim">Positive allosteric modulator of the GABA-A receptor at the benzodiazepine binding site (α-γ subunit interface), enhancing chloride ion conductance and consequent neuronal inhibition. The long elimination half-life is the clinical signature: smoother symptom coverage than short-acting alternatives but greater accumulation, longer next-day sedation, and longer protracted withdrawal.</vote> Strong CYP3A4 substrate; CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir, grapefruit juice) substantially raise plasma exposure. Tolerance to anxiolytic effect, dependence, and significant withdrawal syndrome on abrupt discontinuation; slow taper essential after extended use<ref name="klonopin-label" />. | ||
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== References == | |||
<references /> | |||
[[Category:Benzodiazepines]] | [[Category:Benzodiazepines]] | ||
[[Category:Anxiolytics]] | [[Category:Anxiolytics]] | ||
[[Category: | [[Category:Anticonvulsants]] | ||
[[Category: | [[Category:Schedule IV controlled substances]] | ||