Clonapax (Clonapax) is a benzodiazepine. Clonapax affects chemicals in the brain that may be unbalanced. Clonapax is also a seizure medicine, also called an anti-epileptic drug.
Clonapax is used to treat certain seizure disorders (including absence seizures or Lennox-Gastaut syndrome) in adults and children.
Clonapax is also used to treat panic disorder (including agoraphobia) in adults.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Orally Disintegrating Tablets USP are 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, Clonapax
Orally Disintegrating Tablets USP may be useful.
In some studies, up to 30% of patients have shown a loss of anticonvulsant activity, often within 3 months of administration. In some cases, dosage adjustment may reestablish efficacy.
Orally Disintegrating Tablets USP are indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV. Panic disorder is characterized by the occurrence of unexpected panic attacks and associated concern about having additional attacks, worry about the implications or consequences of the attacks, and/or a significant change in behavior related to the attacks.
The efficacy of Clonapax was established in two 6 to 9 week trials in panic disorder patients whose diagnoses corresponded to the DSM-IIIR category of panic disorder.
Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes.
The effectiveness of Clonapax in long-term use, that is, for more than 9 weeks, has not been systematically studied in controlled clinical trials. The physician who elects to use Clonapax
Orally Disintegrating Tablets USP for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.
How should I use Clonapax?
Use Clonapax orally disintegrating tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Take Clonapax orally disintegrating tablets by mouth with or without food.
Do not remove the blister from the outer pouch until you are ready to take Clonapax orally disintegrating tablets. Make sure that your hands are dry when you open the blister pack. Do not push the tablet through the foil. Peel back the foil on the blister pack and place the tablet on your tongue. The tablet dissolves quickly and can be swallowed with saliva. Take Clonapax orally disintegrating tablets with water. Take the tablet immediately after opening the blister pack. Do not store the removed tablet for future use
If you are taking Clonapax orally disintegrating tablets for the prevention of seizures, taking Clonapax orally disintegrating tablets at the same times each day will help you remember to take it.
Continue to take Clonapax orally disintegrating tablets even if you feel well. Do not miss any doses. Clonapax orally disintegrating tablets works best when there is a constant level of Clonapax orally disintegrating tablets in your body.
If you miss a dose of Clonapax orally disintegrating tablets and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Clonapax orally disintegrating tablets.
Uses of Clonapax in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use: Labeled Indications
Panic disorder: Treatment of panic disorder, with or without agoraphobia.
Seizure disorders: Mono- or adjunctive therapy in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic, and myoclonic seizures; absence seizures (petit mal) unresponsive to succinimides.
Off Label Uses
Bipolar disorder, manic or mixed episodes
Data from a meta-analysis of 5 randomized, controlled trials supports the use of Clonapax in the treatment of acute bipolar mania. Additional data may be necessary to further define the role of Clonapax in this condition.
Based on the American Academy of Neurology guideline for the treatment of tardive syndromes, Clonapax given for tardive dyskinesia is probably effective in decreasing tardive dyskinesia symptoms in the short-term (approximately 3 months) and is suggested for the short-term treatment of tardive dyskinesia.
Data from a limited number of patients studied in a single-blind and two retrospective studies suggest that Clonapax may be beneficial for multifocal tic disorder or Tourette disorder. Additional data may be necessary to further define the role of Clonapax in these conditions.
Clonapax is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one.
Generic name: Clonapax 0.5mg
Dosage form: tablets
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Clonapax is available as a tablet. The tablets should be administered with water by swallowing the tablet whole.
The initial dose for adults with seizure disorders should not exceed 1.5 mg/day divided into three doses. Dosage may be increased in increments of 0.5 to 1 mg every 3 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 result in an increase of depressant adverse effects. This should be considered before adding Clonapax to an existing anticonvulsant regimen.
Clonapax 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.
There is no clinical trial experience with Clonapax in seizure disorder patients 65 years of age and older. In general, elderly patients should be started on low doses of Clonapax and observed closely.
The initial dose for adults with panic disorder is 0.25 mg bid. An increase to the target dose for most patients of 1 mg/day may be made after 3 days. The recommended dose of 1 mg/day is based on the results from a fixed dose study in which the optimal effect was seen at 1 mg/day. Higher doses of 2, 3 and 4 mg/day in that study were less effective than the 1 mg/day dose and were associated with more adverse effects. Nevertheless, it is possible that some individual patients may benefit from doses of up to a maximum dose of 4 mg/day, and in those instances, the dose may be increased in increments of 0.125 to 0.25 mg bid every 3 days until panic disorder is controlled or until side effects make further increases undesired. To reduce the inconvenience of somnolence, administration of one dose at bedtime may be desirable.
Treatment should be discontinued gradually, with a decrease of 0.125 mg bid every 3 days, until the drug is completely withdrawn.
There is no body of evidence available to answer the question of how long the patient treated with Clonapax should remain on it. Therefore, the physician who elects to use Clonapax for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.
There is no clinical trial experience with Clonapax in panic disorder patients under 18 years of age.
There is no clinical trial experience with Clonapax in panic disorder patients 65 years of age and older. In general, elderly patients should be started on low doses of Clonapax and observed closely.
Effect of Clonapax on the Pharmacokinetics of Other Drugs: Clonapax does not appear to alter the pharmacokinetics of phenytoin, carbamazepine, or phenobarbital. The effect of Clonapax on the metabolism of other drugs has not been investigated.
Effect of Other Drugs on the Pharmacokinetics of Clonapax: Literature reports suggest that ranitidine, an agent that decreases stomach acidity, does not greatly alter Clonapax pharmacokinetics.
In a study in which the 2 mg Clonapax 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 Clonapax was 10% lower and the Cmax of Clonapax 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 Clonapax. Cytochrome P-450 inducers, such as phenytoin, carbamazepine and phenobarbital, induce Clonapax metabolism, causing an approximately 30% decrease in plasma Clonapax levels. Although clinical studies have not been performed, based on the involvement of the cytochrome P-450 3A family in Clonapax metabolism, inhibitors of this enzyme system, notably oral antifungal agents, should be used cautiously in patients receiving Clonapax.
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.
The adverse experiences for Clonapax are provided separately for patients with seizure disorders and with panic disorder.
The most frequently occurring side effects of Clonapax are referable to CNS depression. Experience in treatment of seizures 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, including those identified during postapproval use of Clonapax are:
Dermatologic: Hair loss, hirsutism, skin rash, ankle and facial edema
Psychiatric: Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances). The following paradoxical reactions have been observed: excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams
Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages
Adverse events during exposure to Clonapax were obtained by spontaneous report and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, CIGY dictionary terminology has been used to classify reported adverse events, except in certain cases in which redundant terms were collapsed into more meaningful terms, as noted below.
The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation.
Adverse Findings Observed In Short-Term, Placebo-Controlled Trials
Adverse Events Associated With Discontinuation Of Treatment
Overall, the incidence of discontinuation due to adverse events was 17% in Clonapax compared to 9% for placebo in the combined data of two 6-to 9-week trials. The most common events ( ≥ 1%) associated with discontinuation and a dropout rate twice or greater for Clonapax than that of placebo included the following:
Table 2 : Most Common Adverse Events ( ≥ 1%) Associated with Discontinuation of Treatment
Intellectual Ability Reduced
Adverse Events Occurring At An Incidence Of 1% Or More Among Clonapax-Treated Patients:
Table 3 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred during acute therapy of panic disorder from a pool of two 6to 9-week trials. Events reported in 1% or more of patients treated with Clonapax (doses ranging from 0.5 to 4 mg/day) and for which the incidence was greater than that in placebo-treated patients are included.
The prescriber should be aware that the figures in Table 3 cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and nondrug factors to the side effect incidence in the population studied.
* Events reported by at least 1% of patients treated with Clonapax and for which the incidence was greater than that for placebo.
† Indicates that the p-value for the dose-trend test (Cochran-Mantel-Haenszel) for adverse event incidence was ≤ 0.10.
‡ Denominators for events in gender-specific systems are: n=240 (Clonapax), 102 (placebo) for male, and 334 (Clonapax), 192 (placebo) for female.
Commonly Observed Adverse Events
Table 4 : Incidence of Most Commonly Observed Adverse Events* in Acute Therapy in Pool of 6-to 9-Week Trials
Adverse Event (Genentech Preferred Term)
* Treatment-emergent events for which the incidence in the Clonapax patients was ≥ 5% and at least twice that in the placebo patients.
Treatment-Emergent Depressive Symptoms
In the pool of two short-term placebo-controlled trials, adverse events classified under the preferred term “depression” were reported in 7% of Clonapax-treated patients compared to 1% of placebo-treated patients, without any clear pattern of dose relatedness. In these same trials, adverse events classified under the preferred term “depression” were reported as leading to discontinuation in 4% of Clonapax-treated patients compared to 1% of placebo-treated patients. While these findings are noteworthy, Hamilton Depression Rating Scale (HAM-D) data collected in these trials revealed a larger decline in HAM-D scores in the Clonapax group than the placebo group suggesting that clonazepamtreated patients were not experiencing a worsening or emergence of clinical depression.
Other Adverse Events Observed During The Premarketing Evaluation Of Clonapax In Panic Disorder
Following is a list of modified CIGY terms that reflect treatment-emergent adverse events reported by patients treated with Clonapax at multiple doses during clinical trials. All reported events are included except those already listed in Table 3 or elsewhere in labeling, those events for which a drug cause was remote, those event terms which were so general as to be uninformative, and events reported only once and which did not have a substantial probability of being acutely life-threatening. It is important to emphasize that, although the events occurred during treatment with Clonapax, they were not necessarily caused by it.
Events are further categorized by body system and listed in order of decreasing frequency. These adverse events were reported infrequently, which is defined as occurring in 1/100 to 1/1000 patients.
Body as a Whole: weight increase, accident, weight decrease, wound, edema, fever, shivering, abrasions, ankle edema, edema foot, edema periorbital, injury, malaise, pain, cellulitis, inflammation localized
Central and Peripheral Nervous System Disorders: migraine, paresthesia, drunkenness, feeling of enuresis, paresis, tremor, burning skin, falling, head fullness, hoarseness, hyperactivity, hypoesthesia, tongue thick, twitching
Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (eg, convulsions, psychosis, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuance of Clonapax. 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 (eg, 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 Clonapax or other psychotropic agents because of the predisposition of such patients to habituation and dependence.
Following the short-term treatment of patients with panic disorder in Studies 1 and 2, patients were gradually withdrawn during a 7-week downward-titration (discontinuance) period. Overall, the discontinuance period was associated with good tolerability and a very modest clinical deterioration, without evidence of a significant rebound phenomenon. However, there are not sufficient data from adequate and well-controlled long-term Clonapax studies in patients with panic disorder to accurately estimate the risks of withdrawal symptoms and dependence that may be associated with such use.
You should not use this medication if you have severe liver disease, of if you are allergic to Clonapax or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
Clonapax may cause harm to an unborn baby, and may cause breathing or feeding problems in a newborn. But having seizures during pregnancy could harm both mother and baby. Do not start or stop taking Clonapax during pregnancy without medical advice.
You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, irritable, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Before you take Clonapax, tell your doctor if you have kidney or liver disease, glaucoma, any breathing problems, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.
Do not drink alcohol while taking Clonapax. This medication can increase the effects of alcohol.
Clonapax may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it.
DailyMed. "CLONAZEPAM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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