DOSAGE AND ADMINISTRATION
Clonazepam is available as a tablet or an orallydisintegrating tablet (wafer). The tablets should be administeredwith water by swallowing the tablet whole. The orally disintegratingtablet should be administered as follows: After opening the pouch,peel back the foil on the blister. Do not push tablet through foil.Immediately upon opening the blister, using dry hands, remove thetablet and place it in the mouth. Tablet disintegration occurs rapidlyin saliva so it can be easily swallowed with or without water.
Seizure Disorders
Adults
The initial dose for adults with seizure disordersshould not exceed 1.5 mg/day divided into three doses. Dosage maybe increased in increments of 0.5 to 1 mg every 3 days until seizuresare adequately controlled or until side effects preclude any furtherincrease. Maintenance dosage must be individualized for each patientdepending upon response. Maximum recommended daily dose is 20 mg.
The use of multiple anticonvulsants may result in an increaseof depressant adverse effects. This should be considered before addingKlonopin to an existing anticonvulsant regimen.
Pediatric Patients
Klonopin is administered orally. In order to minimizedrowsiness, the initial dose for infants and children (up to 10 yearsof age or 30 kg of body weight) should be between 0.01 and 0.03 mg/kg/daybut 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 thirdday until a daily maintenance dose of 0.1 to 0.2 mg/kg of body weighthas been reached, unless seizures are controlled or side effects precludefurther increase. Whenever possible, the daily dose should be dividedinto three equal doses. If doses are not equally divided, the largestdose should be given before retiring.
Geriatric Patients
There is no clinical trial experience with Klonopinin seizure disorder patients 65 years of age and older. In general,elderly patients should be started on low doses of Klonopin and observedclosely (see PRECAUTIONS: GeriatricUse).
Panic Disorder
Adults
The initial dose for adults with panic disorder is0.25 mg bid. An increase to the target dose for most patients of 1mg/day may be made after 3 days. The recommended dose of 1 mg/dayis based on the results from a fixed dose study in which the optimaleffect was seen at 1 mg/day. Higher doses of 2, 3 and 4 mg/day inthat study were less effective than the 1 mg/day dose and were associatedwith more adverse effects. Nevertheless, it is possible that someindividual patients may benefit from doses of up to a maximum doseof 4 mg/day, and in those instances, the dose may be increased inincrements of 0.125 to 0.25 mg bid every 3 days until panic disorderis controlled or until side effects make further increases undesired.To reduce the inconvenience of somnolence, administration of one doseat bedtime may be desirable.
Treatment shouldbe discontinued gradually, with a decrease of 0.125 mg bid every 3days, until the drug is completely withdrawn.
There is no body of evidence available to answer the question ofhow long the patient treated with clonazepam should remain on it.Therefore, the physician who elects to use Klonopin for extended periodsshould periodically reevaluate the long-term usefulness of the drugfor the individual patient.
Pediatric Patients
There is no clinical trial experience with Klonopinin panic disorder patients under 18 years of age.
Geriatric Patients
There is no clinical trial experience with Klonopinin panic disorder patients 65 years of age and older. In general,elderly patients should be started on low doses of Klonopin and observedclosely (see PRECAUTIONS: GeriatricUse).
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