Brands, Medical Use, Clinical Data
Brands / Synonyms
Antelepsin; Antilepsin; Chlonazepam; Cloazepam; Clonazepam; Clonazepamum; Clonopin; Iktorivil; Klonopin; Klonopin Rapidly Disintegrating; Landsen; Rivotril
Used as an anticonvulsant in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures.
Clonazepam, a benzodiazepine, is used primarily as an anticonvulsant in the treatment of absence seizures, petit mal variant seizures (Lennox-Gastaut syndrome), akinetic and myoclonic seizures, and nocturnal myoclonus.
Mechanism of Action
Allosteric interactions between central benzodiazepine receptors and gamma-aminobutyric acid (GABA) receptors potentiate the effects of GABA. As GABA is an inhibitory neurotransmitter, this results in increased inhibition of the ascending reticular activating system. Benzodiazepines, in this way, block the cortical and limbic arousal that occurs following stimulation of the reticular pathways.
Clonazepam is rapidly and completely absorbed after oral administration. The absolute bioavailability of clonazepam is about 90%.
Somnolence, confusion, coma, and diminished reflexes
Biotrnasformation / Drug Metabolism
Hepatic (cytochrome P450, including CYP3A). Biotransformation occurs mainly by reduction of the 7-nitro group to the 4-amino derivative. This derivative can be acetylated, hydroxylated, and glucuronidated.
Clonazepam is not indicated in patients with epilepsy who have been treated with benzodiazepines. Antagonism of the benzodiazepine effect in such patients may provoke seizures. Serious sequelae are rare unless other drugs or alcohol have been taken concomitantly.
Effect of Clonazepam on the Pharmacokinetics of Other Drugs: Clonazepam does not appear to alter the
pharmacokinetics of phenytoin, carbamazepine, or phenobarbital. The effect of clonazepam on the metabolism of other
drugs has not been investigated.
Effect of Other Drugs on the Pharmacokinetics of Clonazepam: Literature reports suggest that
ranitidine, an agent that decreases stomach acidity, does not greatly alter clonazepam pharmacokinetics.
In a study in which the 2 mg clonazepam orally disintegrating tablet was administered with and without
propantheline (an anticholinergic agent with multiple effects on the GI tract) to healthy volunteers, the AUC of
clonazepam was 10% lower and the Cmax of clonazepam was 20% lower when the orally disintegrating tablet
was given with propantheline compared to when it was given alone.
Fluoxetine does not affect the pharmacokinetics of clonazepam. Cytochrome P-450 inducers, such as phenytoin,
carbamazepine and phenobarbital, induce clonazepam metabolism, causing an approximately 30% decrease in plasma
clonazepam levels. Although clinical studies have not been performed, based on the involvement of the cytochrome
P-450 3A family in clonazepam metabolism, inhibitors of this enzyme system, notably oral antifungal agents, should be
used cautiously in patients receiving clonazepam.
Pharmacodynamic 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.