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clonazepam
generic
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 0.5 mg, 1 mg, 2 mg; ODT: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg
seizure disorder
- [individualize dose PO tid]
- Start: up to 0.5 mg PO tid, may incr. by 0.5-1 mg/day q3 days; Max: 20 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
panic disorder
- [0.5-1 mg PO bid]
- Start: 0.25 mg PO bid, may incr. by 0.25-0.5 mg/day q3 days; Max: 4 mg/day; Info: consider lower start dose in elderly pts; taper dose by no more than 0.25 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
anxiety (off-label)
- [0.25-0.5 mg PO bid-tid]
- Start: 0.25 mg PO bid, may incr. by 0.25 mg/day q1-2 days; Max: 4 mg/day; Info: consider lower start dose in elderly pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
restless legs syndrome (off-label)
- [0.5-2 mg PO qhs]
- Start: 30min before bedtime; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
confusional arousals (off-label)
- [0.5-2 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleep terrors (off-label)
- [0.5-2 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleepwalking (off-label)
- [0.5-2 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
rapid eye movement sleep behavior disorder (off-label)
- [0.5-1 mg PO qhs]
- Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
burning mouth syndrome (off-label)
- [0.25-2 mg/day PO divided qd-tid]
- Start: 0.25-0.5 mg PO qhs x1wk, may incr. by 0.25-0.5 mg/day qwk; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
Tourette syndrome (off-label)
- [0.25-3 mg/day PO divided bid-tid]
- Max: 6 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- renal impairment: no adjustment; Info: metabolite accumulation possible
- HD: no adjustment; no supplement; PD: not defined; Info: metabolite accumulation possible
hepatic dosing
- [see below]
- significant impairment: contraindicated
Peds Dosing .
- Dosage forms: TAB: 0.5 mg, 1 mg, 2 mg; ODT: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg
seizure disorder
- [<10 yo or <30 kg]
- Dose: 0.1-0.2 mg/kg/day PO divided bid-tid; Start: 0.01-0.03 mg/kg/day PO divided bid-tid, incr. by up to 0.25-0.5 mg/day q3 days; Max: 0.05 mg/kg/day for initial dose; Info: give largest divided dose qhs; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [10 yo and older or >30 kg]
- Dose: individualize dose PO tid; Start: up to 0.5 mg PO tid, may incr. by 0.5-1 mg/day q3 days; Max: 20 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleep terrors (off-label)
- [2 yo and older]
- Dose: 0.125-0.25 mg PO qhs; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
sleepwalking (off-label)
- [2 yo and older]
- Dose: 0.125-0.25 mg PO qhs; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
rapid eye movement sleep behavior disorder (off-label)
- [2 yo and older]
- Dose: 0.25-0.5 mg PO qhs; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
Tourette syndrome (off-label)
- [6 yo and older]
- Dose: 0.25-3 mg/day PO divided bid-tid; Start: 0.25 mg/day PO divided bid-tid, titrate slowly; Max: 6 mg/day; Info: taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [see below]
- significant impairment: contraindicated