Clonazepam...helpful info needed

[dieselboy]

I'm not advocating use, just looking for some helpful info.
I rarely drink, and usu. have no more than 3. I've tried clonazepam (klonopin) 1 green tab--instead of drinking when I go out,and I find it mellows me out just enough, still cognizant, but relaxed, I sleep well, and feel great the next day...able to wake on time to eat and train.

Any risks, to this? I know this can be habit forming, but I've only done it 2 times w/ in the past 3 months at that dosage.

Is there a rebound effect on anxiety levels?

[keith1569]

http://www.erowid.org/pharms/clonaze...onazepam.shtml you can check out sum stuff there..it could be helpful..i believe that it could become habit forming if dont enogh...but 2 times in 3 months is nothing..

[JOEYZ]

Here is some info and a drug profile:


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Paradoxical effect from Klonopin [posted 1/7/99]
Question: Can Klonopin or other medications in the benzodiazepine family cause a paradoxical effect?

Answer: Yes.

Klonopin [posted 1/5/99]
Question: My doctor has prescribed Klonopin and has directed me to take one tab for Anxiety. I do not have extreme and regular bouts of anxiety so I only take it when needed. Is it safe to take it this way? I have had a three months supply that has lasted for a little over a year.

Answer: Yes, and less addicting.

Klonopin & Rivotril Questions [posted 12/01/98]
Question: I am a patient that has a form of dystonia called spasmodic torticollis. My neurologist has me on Botox injections every 10 to 11 weeks. As well, He has prescribed Rivotril for me, I am taking the generic drug clonazepam .5mg, up to 4 per day. My question is this the same as klonopin or is there a difference. I was of the understanding that he gave it to me for spasms in my neck, yet I read that klonopin is an anticonvulsive drug. Am I correct? What is the difference between rivotril and klonopin? Any help would greatly be appreciated.

Answer: Same and the class of benzodiazepines is used for muscle relaxation as well as sedation and seizures.

Xanax and Klonopin [posted 12/01/98]
Question: Have panic disorder. Dr. prescribed 1-1/2 .25 Xanax morning, noon, dinner, and 2 .25(.5) at night for sleeping. Take nighttime dose around 10p.m. because I feel so sedated I can't wait any longer, but wake up every morning around 4a.m. Have awake and half asleep. Get up and take morning dose around 7a.m. and then have a bad 2-3 hours. Dr. just ordered .5 Klonopin to take instead of Xanax at bedtime. Is it o.k. to mix the two? I feel if I could just get a full night's sleep, I could handle the mornings better. I might add that I'm very sensitive to all drugs, and, in my opinion, need less Xanax than I'm taking, but the doctor wants to give more and more. Please help! I also am in therapy. Thank you for any help - greatly appreciated.

Answer: Klonopin and Xanax are very similar in effect, level of sedation and dosage would be the significant variables. Usually we use one or the other not both, but it is ok to mix the two.


Could Muscle Twitching be Due to Klonopin [posted 11/25/98]
Question: I was put on klonopin for anxiety and an eyelid twitch. The eye lid twitch is gone, however it was gone before I began the klonopin. I take a forth of a .25 dose when I need it. So basically I may take it 3 days then stop then a week later I'll take one and so on. I am now having muscle twitches all over my body ...could this be a result of sporadic taking klonopin? Also, I take such a small dose because its all I need to do the job. A 1/2 of a pill seems to give me some strange pain in my arms and really knock me out making me feel hung over the next day.

Answer: Possibly due to the Klonopin;but, would be uncommon. The hang over feeling is a common one.

Using Klonopin As a Sleep Aid [posted 11/24/98]
Question: My doctor prescribed Klonopin about six months ago because I could not sleep well at night. I take one 2mg tablet about 20 min.before bedtime and I sleep like a rock and wake well rested and ready for another hard day at work. The problem is I worry about taking the drug for a long time. Should I be worried about long term use of this drug?

Answer: Don't do this. There are plenty of ways to address sleep without huge daily doses of klonopin. Most physicians would use 0.5 or 0.25 as a starter dose. This is a huge dose. Try Tylenol PM or melatonin or benadryl and use the klonopin as a last resort-but a smaller dose.

Klonopin: Memory & Addiction Concerns [posted 11/18/98]
Question: I am a 51 yr. old female. I was finally diagnosed with panic disorder about 4 years ago. At that time I was given Klonopin and Zoloft. I weaned myself off the zoloft. Since taking the klonopin, I feel my memory is gone. Is this old age or a result of this drug. I have trouble finding words and remembering names. My Psychiatrist says the drug is safe and I am fine. My internal medicine doctor says this is one of the strongest and most serious drugs out there. I want off this drug. I can feel the addiction as my body clock sounds the alarm for klonopin! How can you tell when the cluster of panic is gone? I am scared of the whole thing!

Answer: Panic disorder tends to be lifelong;although some patients have episodic problems and not continual anxiety/panic. Of the two drugs, you would be better on the zoloft since it is not addicting. However, if you need klonopin so be it. The memory loss might be the klonopin and I would try to use the klonopin only occasionally and substitute the zoloft on an every day basis. Consult your doctor for the specific steps. Do not stop the drug "cold turkey".

Klonopin & Blood Sugar [posted 11/18/98]
Question: My husband is concerned about Klonopin and the effects it might have on blood sugar levels. Is there any information on drugs and the possibility of them raising your blood sugar level? I would appreciate any information you could give me. Thank you.

Answer: Little or none in clinical practice

Klonopin & Xanax [posted 11/11/98]
Question: Please advise me the strength comparison between Xanax and Klonopin. In order to transfer me from Xanax to Klonopin my Psychiatrist has recommended that I take two mg. of klonopin five times a day in addition to the Zanax and Zoloft. I am already hypersedated. He believes that Klonopin is only 1/4th as strong as Xanax and thus the reason for the heavy dose. I want to transfer to the longer acting bz. to prevent break through anxiety and to help taper the bz. to a lower dose level. I am afraid however that my doctor is not correct about the dose comparisons between these two drugs and that it would be two great an amount of benzos. to take.

Answer: They're pretty similar and his numbers are about right.

Klonopin & Pregnancy [posted 11/6/98]
Question: My daughter takes klonopin for panic attacks. She takes one half of .5 mg once a day. She has recently found out that she is pregnant and we were wondering if she should get off this drug.

Answer: optimally use as little as possible. Larger doses will potentially result in physical dependence in the fetus. However, the antidepressant drugs are less well followed during pregnancy with less predictable side effects. I would use what is necessary to keep control-but as little as possible.

Ok to Take Nytol While Tapering Off Klonopin [posted 11/5/98]
Question: I have been taking 0.5 mg klonopin for 2 years and I would like to try to get off it and get back to seeping without drugs. would it hurt to take an over the counter like nytol while tapering off klonopin?

Answer: NO. Just taper slowly. (see below)

Tapering Off Klonopin [posted 11/3/98]
Question: I have been taking 2 mg. of Klonopin for weeks now and it is time to taper off. How do you suggest that I do so without having serious problems. I have been taking it twice a day.

Answer: Cut it about 20% and keep the dose 4-5 days then cut another 20%.

Zoloft Withdrawal or Klonopin Side Effects [posted 10/29/98]
Question: Since 1987 I have suffered from panic attacks, at the time the medicine of choice was Nopromin and Klonopin, when I became pregnant in 1990, I had to come off of these drugs. I was able to make it, and 3 months after I had my child, I began to have panic attacks again. I was on a placebo program, and then received free treatment for 6 months. I was on Prozac with really bad side effects, then the doctor put me on Zoloft and Klonopin. Since 1991 I have been on Zoloft and Klonopin in a variety of doses. My new doctor reduced my Zoloft first by half, now he has taken me off it completely, because I had a side effect of the inability to achieve an orgasm. Now I'm on .05 mg. of Klonopin in the morning, .05 of Klonopin at lunch and two 1mg tablets of Klonopin before bed time. This has been almost two weeks ago. Is it a side effect of Klonopin to become nauseous throughout the day, and to have severe problems with your ears?

Answer: Not usually, but possibly a withdrawal syndrome from the SRI drugs.

Could Klonopin Be Responsible for Bladder Problems [posted 10/23/98]
Question: I have been on Klonopin for 10 years. I have frontal brain damage from my ex husband. This drug has given me back many functions I thought were from just anxiety. I am now not going through a divorce with three little children but when I have the flu or any thing that impedes the delivery of the drug into my body I and others notice my decreased abilities. Now I have had a long term bladder problem with an infection and 11 pieces removed to be checked for cancer. It is all cancer free but what is causing the bladder to become defective? Is it the klonopin? Is there another better drug of choice to try as I have years while I have to work to support my self. Thank you for any help.

Answer: Not the klonopin, I doubt that I would change the klonopin as effective as it sounds.

Klonopin Side Effects
Question: Can you tell me the side effects .....physical withdrawal symptoms of a dosage change with the drug "Klonopin"....From 1 Mg to 0.25 Mg, overnight,and how long before the symptoms would manifest themselves?

Answer: It would depend a great deal on why she was taking the drug. That is, how much of her previous symptoms reoccur and how much is drug withdrawal. Drug withdrawal is usually manifested by agitation, anxiety and occasional GI pain.

Klonopin Side Effects
Question: I am looking for information on the drug klonopin. My 9 month old son just started taking it for seizures. What are the side effects?

Answer: Klonopin is an effective anti-seizure medication that belongs to the same general class of drugs as Valium, Librium, etc. Like these drugs, it produces sedation, decreased attention span, and long term physical dependence.

Klonopin
Question: I have been taking klonopin for panic attacks. I now want to discontinue using the drug. I am currently taking 1/2 of 0.05 mg once a day. How should I taper off of such a small dose?

Answer: About a week would be more than enough.

Long term effects
Question: For the past year and a half I’ve experienced obsessive worry and resulting insomnia. I had very bad side effects with Paxil and Prozac. Currently, I take a small dose of Klonopin. I don't like taking a tranquilizer. The klonopin is workable for now, but I'm concerned about long term effects. I'd like to get back to a drug free restful sleep.

Answer: Klonopin is very effective. I'd focus on its effectiveness. If it works and other less addictive drugs do not, then stick with it. You could try other alternatives, but don't fix it if it ain't broke.

Klonopin
Question: I have Restless Leg Syndrome. My Doctor has me take 1 mg of Klonopin at bedtime. It works well for me. Many articles on the subject warn about suddenly stopping the use of Klonopin. I would like to know what problems I might have if I miss a night once in a while. Also, can I get physically hooked on this daily dosage?

Answer: Abruptly stopping Klonopin can lead to irritability and even to seizures in some cases. Any drug of this class used on a regular basis can produce dependence. However, there are few effective treatments for Restless Leg, and if it really works, I would be reluctant to stop it. Missing one day is unlikely to produce withdrawal at these doses.

Klonopin and MVPS
Question: I have a mitral valve prolapse with all the symptoms(Panic attacks, insomnia, extreme fatigue, IBS, etc..), and I have been instructed by the Society for MVPS to ask my doctor about getting on Klonopin. Will it help all of these symptoms? What about the drug called Buspar? Which one should I take?

Answer: Klonopin is often very effective in minimizing the symptoms of MVP--especially anxiety and panic. However, it is addictive and should be avoided unless you are really incapacitated. Buspar might be useful, and it doesn't appear to be addicting. Also, betablockers often will block most of the symptoms and are not addicting. If you were to take klonopin when you had severe problems that would be OK. Taking it regularly buys you other problems. Occasionally, SRI antidepressants are helpful since many have MVP and many have panic disorders-- differentiating them is difficult. As a consequence, you might try the SRI antidepressants.

Klonopin
Question: I was wondering if you could answer a few questions on Klonopin? If I were taking 1/2 of a 0.5 mg tablet 2 times a day and a whole at night , then was suddenly taking twice that amount, then suddenly back to the original dosage, would there be any effects from it?

Answer: Only a little sedation while taking the extra Klonopin.

Klonopin
Question: My 11 month old son was prescribed Klonopin for a sleeping disorder. He takes half of a 0.5. Is this safe for a child his age? What are the risks involved with this drug and an infant? He weighs 21 lbs.

Answer: I'd need to know the nature of the sleep disorder before I could help. In general, Klonopin is a very effective sedative but is addicting over the long term. If your son needs it, so be it. There are few alternatives to this drug or similar drugs as sedatives for sleeping. You'll need to accept the potential long term addicting properties to overcome his sleep problem.

Klonopin
Question: I am a 27 year old male, currently taking Trandate and Lozol for hypertension. I had visited my doctor and told him about the frequent nightmares from which I suffer, and he had noted that they could be caused by the Trandate. He prescribed Klonopin, 1 mg nightly, as a way of dealing with the night terrors. Is this a common use for the drug, and how effective is it for others?

Answer: There are at least 8 different classes of drugs for treating hypertension. Usually, if a patient experiences symptoms with one class I switch to another class of drugs. This is particularly important with a young adult since they will be taking the medications for a long period of time. I would never prescribe a potentially addicting medication to cover side effects unless it was life or death. I would strongly recommend a different treatment course. Also, if you have not have screening done for the preventable types of hypertension this should be done. There are about 7- 8 types of hypertension that can be surgically cured. Usually, I screen young adults(below 40) for these causes since surgery can fix the problem. Also, knowing your rennin status will predict which drugs will work best on your hypertension-with your age this is vital information. If your physician does not feel competent to do this testing it can be performed by most Internists or Endocrinologist. Hypertension clinics at University teaching hospitals are also an alternative.

Klonopin Therapy
Question: After two years of being given various drugs such as prozac, lithium, serzone, wellbutrin, and effexor and undergoing 12 rounds of ect, my severe clinical depression still persists. My doctor is suggesting I wean myself off antidepressants and give Klonopin a try. While knowing that it is principally an anticonvulsant, I have also read that it is used in depression. Do you have any information or resources which can assist my understanding of this approach?

Answer: Klonopin or Clonazepam is a Benzodiazepine which has been used in seizure disorders and in anxiety states. Its use in depression has not been reported.

Klonopin For Facial Tics
Question: I was diagnosed with facial tics (I'm 33 and have had them since I was 8). Originally, I was put on Zoloft. It seemed to be working, however it seriously decreased my sexual drive. This bothered me enough that my doctor stopped the Zoloft and put me on Klonopin instead. The Klonopin is not supposed to affect sexual drive. I've just started taking the Klonopin, so I don't know how effective it will be. My questions are:
1) Is it common to prescribe Klonopin for facial tics? (I realize that Zoloft and Klonopin are very different types of drugs.)
2) I read about this drug called Serzone which is like Zoloft but does not have the side effect of decreased sexual drive. Since the Zoloft seemed to be generally effective in my case, would Serzone be effective also?

Answer: Serzone is a similar to Zoloft in how it works in the brain. Generally, it does not decrease sexual drive. I would certainly try it in preference to Klonopin. Klonopin may be effective, but is addicting when taken for more than 6 weeks or so.

Klonopin - long term effects
Question: I have been taking Klonopin for the past seven years, and am now up to nearly four, 0.5 mg doses per day by my doctor's approval. Is the effect wearing off? Am I addicted? What effects might this drug have on any major organs such as the liver, brain, heart, etc.? I have a past history of abusing Valium. I haven't taken any Valium for seven years, but realize Klonopin is in the same chemical family.

Answer: Taking this amount of Klonopin over several years will certainly produce a physical addiction. However, it doesn't seem to have other major long term effects. Do not ever stop these drugs "cold turkey" because they can result in seizures. It sounds like you are well controlled on the medication. Consequently, I would keep on it.

Klonopin
Question: Our grown son takes Klonopin for an anxiety problem. Is this drug also used for insomnia?

Answer: Yes, along with many of the other tranquilizer type agents.

Klonopin
Question: I have been on Klonopin for a few months now for treatment of anxiety and panic attacks and I want to try to stop taking it and deal with the anxiety without mediation, under my doctor’s supervision. What is the history of Klonopin, as far as someone getting off of it? my history of anxiety is one of off and on due to certain circumstances in my life. At one time I was symptom free for more than 10 years it came back. I took no medication and it went away again. It came back and I was put on zoloft and then began to have panic attacks at which point I was put on klonopin. Can I once again be drug free and symptom free? Could being on zoloft made my condition worse?

Answer: Panic attacks commonly occur in clusters. That is, several for several weeks or months followed by several months to years of freedom. These attacks tend to run in families and often are improved with SRI drugs like zoloft. This drug would not be expected to worsen the condition. Klonopin is very useful, but also potentially addicting. Unlike heroin or morphine you should not stop this drug "cold turkey" as seizures can occur. Taper this drug slowly and see the effect on the panic attacks. I wouldn't be too concerned - you'll be able to stop the drug once this cluster of panic attacks are over.

Klonopin
Question: My 86-year-old mother started on Klonopin, 1/2 of .5 tablet (orange), two nights ago. This was to help her get off Ativan. She is very drugged, unable to walk around, and unable to function normally. Will this go away? Is this how the body responds at first, and then does it normalize? Will her body adjust? Will the lethargy and sedated feeling go away, or is this an indication she cannot take it?

Answer: Klonopin(clonazepam) is of the class of drugs called benzodiazepines. These include valium, librium, etc. These drugs are used to treat anxiety and some sleep disorders. The major side effect is sedation. While this can decrease, usually the amount of sedation will persist.

Klonopin
Question: I have been on Zoloft for about 5 weeks. To deal with the side effect of anxiety, the doctor put me on klonopin. Since I’ve been on Klonopin, I’ve noticed some shortness of breath. Is this a common side effect of klonopin?

Answer: Klonopin (clonazepam) is normally used in the treatment of anxiety disorders. It is included in the class of drugs called benzodiazepines. These include drugs like valium and librium among others. The most frequent side effects are usually related to central nervous system depression. This includes drowsiness, ataxia (loss of coordination), and behavior problems. As with most drugs, there is a long list of other reported side effects. These include shortness of breath (dyspnea). However, this is not a usual or common side effect of this drug.

Klonopin for Myoclonus
Question: I've been on klonopin for 18 months for myoclonus. I dislike the lethargy this drug brings. I am not sharp as usual. And, more important, I really can't see that it holds me even for 50% of the time. What are suitable alternatives for noctural myoclonus or PLMDS? I need to get back to my professional work with confidence. Klonopin has got to go--with me anyway. Suggestions? Or, can you tell me more about the addictive nature of this drug? I have tried to slowly get off it (2 0.5 mg tabs before bed) and got down to 1/2 tab--and then the shaking began again. I need to know: was that shaking from getting off the Klonopin or because I was not covered enough by it and the original condition was twitching through?

Answer: There are several opinions for patients looking for treatment for Restless Legs Syndrome(RLS), or for Periodic Leg Movement of Sleep(PLMS). EVERY PATIENT WILL RESOPOND DIFFERENTLY BOTH IN TERMS OF BENEFIT AND SIDE EFFECTS SO "YOUR MILAGE MAY VARY". Many patients have been tried with success on dopamine like medications which are used most commonly for the treatment of Parkinson's disease. Agents such as Sinemet, Parlodel, or Permax have become very popular in recent years. For younger patients taking these agents especially only in the evening or at bedtime, major side effects are not common. GI upset, lightheadedness are some but certainly not the only ones that can be encountered. More recently the Drug Neurontin which is FDA approved only for add on therapy for seizures has also found many proponents in this country. Other less commonly used medication include some of the other anti-seizure medications like Depakote. Baclofen which is an anti-spastically agent has also been tried. Finally the narcotic class of medications have their success stories-this category of meds used to be the most popular but for obvious reasons has fallen into disrepute.

Severe Depression
Question: After 7 mos. of ultimately reaching 40mg Paxil & 40mg Buspar to no appreciable beneficial effect, I have just started 20mg of Prozac for severe clinical depression plus Klonopin for extreme panic disorder. The limited info I know about Klonopin is that it seems to have a longer life than Xanax which is more an immediate "fix" and short lived which obviously presents the risk of addiction. My quest: in addition to the Klonopin I also received a script for Xanax. The dosage for Klonopin is 0.5mg with the OK to take as many as 20 in a 24hr period if needed. How do I make the distinction as which to take/can I take both and do they interfere in any way with Prozac? I'm not a stranger to panic disorder however I guess I've felt pretty "smug" or grateful because I saw myself as one of the few success stories. This was 18 yrs ago and with 2 yrs (3x wkly) I recovered with no prolonged medication, biofeedback etc. A specific event 7 mos. ago provided the catalyst for this depression and unbearable pain. Sorry to ramble on - my main concern is how should I treat Klonopin. should I just throw away the Xanax?

Answer: I'd focus on using one of these not both. They have similar effects-although different 1/2 lives. Either one is effective don't use both.




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DESCRIPTION: Klonopin is available as scored tablets containing 0.5 mg, 1 mg or 2 mg clonazepam/Roche. Each tablet also contains lactose, magnesium stearate, microcrystalline cellulose and corn starch, with the following dye systems: 0.5 mg-FD&C Yellow No. 6; 1 mg-FD&C Blue No. 1 and FD&C Blue No. 2.
Chemically, clonazepam is 5-(2-chlorophenyl)-1,3-dihydro7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has a molecular weight of 315.7 and the following structural formula:


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ACTIONS: In laboratory animals, Klonopin exhibits several pharmacologic properties which are characteristic of the benzodiazepine class of drugs. Convulsions produced in rodents by pentylenetetrazol or electrical stimulation are antagonized, as are convulsions produced by photic stimulation in susceptible baboons. A taming effect in aggressive primates, muscle weakness and hypnosis are likewise produced by Klonopin. In humans it is capable of suppressing the spike and wave discharge in absence seizures (petit mal) and decreasing the frequency, amplitude, duration and spread of discharge in minor motor seizures.

Single oral dose administration of Klonopin to humans gave maximum blood levels of drug, in most cases, within one to two hours. The half-life of the parent compound varied from approximately 18 to 50 hours, and the major route of excretion was in the urine. In humans, five metabolites have been identified. In general, the biotransformation of clonazepam followed two pathways: oxidative hydroxylation at the C-3 position and reduction of the 7-nitro function to form 7-amino and/or 7-acetyl-amino derivatives.

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INDICATIONS: Klonopin is useful alone or as an adjunct in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures. In patients with absence seizures (petit mal) who have failed to respond to succinimides, Klonopin may be useful.

In some studies, up to 30% of patients have shown a loss of anticonvulsant activity, often within three months of administration. In some cases, dosage adjustment may reestablish efficacy.

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CONTRAINDICATIONS: Klonopin should not be used in patients with a history of sensitivity to benzodiazepines, nor in patients with clinical or biochemical evidence of significant liver disease. It may be used in patients with open angle glaucoma who are receiving appropriate therapy, but is contraindicated in acute narrow angle glaucoma.

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WARNINGS: Since Klonopin produces CNS depression, patients receiving this drug should be cautioned against engaging in hazardous occupations requiring mental alertness, such as operating machinery or driving a motor vehicle. They should also be warned about the concomitant use of alcohol or other CNS-depressant drugs during Klonopin therapy (see Drug Interactions).

Usage in Pregnancy: The effects of Klonopin in human pregnancy and nursing infants are unknown.

Recent reports suggest an association between the use of anticonvulsant drugs by women with epilepsy and an elevated incidence of birth defects in children born to these women. Data are more extensive with respect to diphenylhydantoin and phenobarbital, but these are also the most commonly prescribed anticonvulsants; less systematic or anecdotal reports suggest a possible similar association with the use of all known anticonvulsant drugs.

The reports suggesting an elevated incidence of birth defects in children of drug-treated epileptic women cannot be regarded as adequate to prove a definite cause and effect relationship. There are intrinsic methodologic problems in obtaining adequate data on drug teratogenicity in humans; the possibility also exists that other factors, e.g., genetic factors or the epileptic condition itself, may be more important than drug therapy in leading to birth defects. The great majority of mothers on anticonvulsant medication deliver normal infants. It is important to note that anticonvulsant drugs should not be discontinued in patients in whom the drug is administered to prevent seizures because of the strong possibility of precipitating status epilepticus with attendant hypoxia and threat to life. In individual cases where the severity and frequency of the seizure disorder are such that the removal of medication does not pose a serious threat to the patient, discontinuation of the drug may be considered prior to and during pregnancy, although it cannot be said with any confidence that even mild seizures do not pose some hazards to the developing embryo or fetus.

These considerations should be weighed in treating or counseling epileptic women of childbearing potential.

Use of Klonopin in women of childbearing potential should be considered only when the clinical situation warrants the risk. Mothers receiving Klonopin should not breast feed their infants. In a two-generation reproduction study with Klonopin given orally to rats at 10 or 100 mg/kg/day, there was a decrease in the number of pregnancies and a decrease in the number of offspring surviving. until weaning. When Klonopin was administered orally to pregnant rabbits at 0.2, 1.0, 5.0 or 10.0 mg/kg/day, a nondose-related incidence of cleft palates, open eyelids, fused sternebrae and limb defects was observed at the 0.2 and 5.0 mg/kg/day levels. Nearly all of the malformations were seen from one dam in each of the affected dosages.

Usage in Children: Because of the possibility that adverse effects on physical or mental development could become apparent only after many years, a benefit-risk consideration of the long-term use of Klonopin is important in pediatric patients.

Withdrawal symptoms of the barbiturate type have occurred after the discontinuation of benzodiazepines. (See DRUG ABUSE AND DEPENDENCE section.)

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PRECAUTIONS: When used in patients in whom several different types of seizure disorders coexist, Klonopin may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). This may require the addition of appropriate anticonvulsants or an increase in their dosages. The concomitant use of valproic acid and clonazepam may produce absence status.

Periodic blood counts and liver function tests are advisable during long term therapy with Klonopin.

The abrupt withdrawal of Klonopin, particularly in those patients on long-term, high-close therapy, may precipitate status epilepticus. Therefore. when discontinuing Klonopin, gradual withdrawal is essential. While Klonopin is being gradually withdrawn. the simultaneous substitution of another anticonvulsant may be indicated. Metabolites of Klonopin are excreted by the kidneys to avoid their excess accumulation, caution should be exercised in the administration of the drug to patients with impaired renal function.

Klonopin may produce an increase in salivation. This should be considered before giving the drug to patients who have difficulty handling secretions. Because of this and the possibility of respiratory depression, Klonopin should be used with caution in patients with chronic respiratory diseases.

Information for Patients: To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.

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ADVERSE REACTIONS: The most frequently occurring side effects of Klonopin are referable to CNS depression. Experience to date has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30%. In some cases, these may diminish with time; behavior problems have been noted in approximately 25% of patients. Others, listed by system, are:

Neurologic: Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, "glassy-eyed" appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo.

Psychiatric: Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis, suicidal attempt (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances).

Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages.

Cardiovascular: Palpitations.

Dermatologic: Hair loss, hirsutism, skin rash, ankle and facial edema.

Gastrointestinal: Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, hepatomegaly, increased appetite, nausea, sore gums.

Genitourinary: Dysuria, enuresis, nocturia, urinary retention. Musculoskeletal: Muscle weakness, pains. Miscellaneous: Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain.

Hematopoietic: Anemia, leukopenia, thrombocytopenia, eosinophilia.

Hepatic: Transient elevations of serum transaminases and alkaline phosphatase.

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DRUG ABUSE AND DEPENDENCE: Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (e.g., convulsions, psychosis,, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuance of clonazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage tapering schedule followed. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving clonazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.

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DRUG INTERACTIONS: The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs.

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OVERDOSAGE: Symptoms of Klonopin overdosage, like those produced by other CNS depressants, include somnolence, confusion, coma and diminished reflexes. Treatment includes monitoring of respiration, pulse and blood pressure, general supportive measures and immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained. Hypotension may be combated by the use of levarterenol or metaraminol.

Methylphenidate or caffeine and sodium benzoate may be given to combat CNS depression. Dialysis is of no known value.

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DOSAGE AND ADMINISTRATION: Infants and Children: Klonopin is administered orally. In order to minimize drowsiness, the initial dose for infants and children (Up to 10 years of age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/day but not to exceed 0.05 mg/kg/day given in two or three divided doses. Dosage should be increased by no more than 0.25 to 0.5 mg every third day until a daily maintenance dose of 0.1 to 0.2 mg/kg of body weight has been reached unless seizures are controlled or side effects preclude further increase. Whenever possible, the daily dose should be divided into three equal doses. If doses are not equally divided, the largest dose should be given before retiring.

Adults: The initial dose for adults should not exceed 1.5 mg/day divided into three doses. Dosage may be increased in increments of 0.5 to 1 mg every three days until seizures are adequately controlled or until side effects preclude any further increase. Maintenance dosage must be individualized for each patient depending upon response. Maximum recommended daily dose is 20 mg.

The use of multiple anticonvulsants may recruit in an increase of depressant adverse effects. This should be considered before adding Klonopin to an existing anticonvulsant regimen.

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HOW SUPPLIED: Scored tablets-0.5 mg, orange; 1 mg, blue; 2 mg, white-bottles of 100; Tel-E-Dose®, packages of 100, available in boxes of four reverse-numbered cards of 25.

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[powerlifter]

Nice post JZ