Clonazepam

About Clonazepam

The label says clonazepam’s antiseizure and antipanic effects are believed to come from enhancing the activity of GABA, a calming signal in the brain. Alone or with other medicines, it is labeled for Lennox-Gastaut syndrome, akinetic and myoclonic seizures, and absence seizures that have not responded to succinimides; it is also labeled for panic disorder, with or without agoraphobia, in adults, and has not been established for panic disorder under 18. For seizures, adults start at no more than 1.5 mg a day in three doses, rising by 0.5 to 1 mg every three days to at most 20 mg a day; children up to 10 years or 30 kg start at 0.01 to 0.03 mg per kg a day. For panic disorder, treatment starts at 0.25 mg twice a day and reaches 1 mg a day after three days, with up to 4 mg a day for some; to stop, the dose is lowered by 0.125 mg twice a day every three days.

The boxed warning says that use with opioids can cause profound sedation, slowed breathing, coma and death; that benzodiazepines expose users to abuse, misuse and addiction, which can lead to overdose or death; and that continued use causes physical dependence, so stopping suddenly or cutting the dose quickly can cause life-threatening withdrawal reactions; the label adds that stopping suddenly can bring on seizures that will not stop (status epilepticus). It must not be taken by people with significant liver disease, acute narrow-angle glaucoma or a history of sensitivity to benzodiazepines. Like other antiseizure medicines, it can raise the risk of suicidal thoughts or behavior. It can impair thinking and driving, increase saliva, affect breathing in people with lung problems and, where several seizure types coexist, bring on or increase generalized tonic-clonic seizures. Drowsiness, unsteadiness and behavior problems are common in seizure treatment, and drowsiness, depression and poor coordination in panic disorder.

As a Schedule IV drug, a prescription can be refilled up to five times within six months of the date written. Refill information can move between pharmacies only once, unless they share a real-time database, and an unfilled electronic prescription can be transferred once at the patient’s request where state law allows. To take a disintegrating tablet, peel back the blister foil rather than pushing the tablet through; some contain phenylalanine, which matters in phenylketonuria. Klonopin’s rapidly disintegrating tablets and its 0.125 and 0.25 mg tablets are discontinued. Use late in pregnancy can cause sedation and withdrawal in the newborn, and pregnant women can join the North American Antiepileptic Drug Pregnancy Registry. Clonazepam passes into breast milk, so a breastfed baby is watched for sleepiness, poor feeding and poor weight gain.

Taking Clonazepam

How to take it

One to three times a day, with or without food, at about the same times each day; if doses are unequal, the largest is taken at bedtime. Open a disintegrating tablet’s blister with dry hands, peel back the foil, and let the tablet dissolve in the mouth, with or without water. Do not stop it on your own.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture, out of reach of children and others. Do not flush it; use a take-back program.

Interactions to know about

Opioids, alcohol and other sedatives deepen sedation and can slow breathing dangerously. Phenytoin, carbamazepine, lamotrigine and phenobarbital lower its levels, and phenytoin levels are monitored when the two are combined; oral antifungals such as fluconazole may raise them. With valproic acid it may cause absence status.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Clonazepam differs from pharmacy to pharmacy

Generic clonazepam tablets have many makers, while disintegrating tablets have only a few; the two cannot be exchanged at the counter. A prescription that names Klonopin and blocks substitution is priced as a brand.

Each pharmacy sets its own cash price, including its dispensing fee, so quotes for the same tablet can differ. The 0.25 mg tablet comes from a single maker.

Ways to pay less for Clonazepam without insurance

• Ask for generic clonazepam, and make sure the prescription does not name Klonopin only.
• Ask whether clonazepam is on the pharmacy’s flat-price generic list, and compare quotes before the first fill, since refill information can be transferred only once.
• If disintegrating tablets are prescribed and you can swallow tablets, ask the prescriber whether regular tablets would suit you.
• Choose the pharmacy before the prescription is sent electronically: an unfilled electronic prescription can be transferred between pharmacies only once, at your request.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Clonazepam

1. 1.Is it safe with my other seizure medicines, pain medicines or sleep aids?
2. 2.Which changes in mood or behavior should I report right away?
3. 3.How would my dose be lowered if I need to stop?
4. 4.How many refills does my prescription carry, and when does it expire?

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