Tracey Spanbauer 1

Medication Card

Name of drug: clonazepam [Klonopin]

Classification: anticonvulsant benzodiazepines

MOA: anticonvulsant effects may be dt presynaptic inhibition. Sedative effects CNS

probably by stimulating inhibitory GABA receptors.

PO: Onset_20-60 min__ Peak__1-2 hrs___ Duration__6-12 hrs____

Dosage: PO [Adult]:0.5 mg 3X daily; may be ↑ by 0.5 mg q 3rd day. Total daily maintenance
dose not to exceed 20 mg. Panic Do: 0.125 mg 2X daily ↑ after 3 days to target dose of 1
mg/day (some pts up to 4mg/day). PO [children < 10 yo or 30 kg]: initial dose 0.01-0.03
mg/kg/day (not to exceed 0.05 mg/kg/day) given in 2-3 equally divided doses, ↑ by no more
than 0.25-0.5 mg q 3rd day until therapeutic blood levels reached (not to exceed 0.2
mg/kg/day).

Side Toxin Effects:

SYSTEM:

CNS (Neuro): behavioral changes, drowsiness, ataxia

Skin/Integumentary: N/A

GI: N/A

Respiratory: N/A

Cardiovascular: N/A

Musculoskeletal: N/A

GU/Reproductive: N/A

Hematopoietic: N/A

Toxicity: Therapeutic serum conc are 20-80 mg/ml. Flumazenil antagonizes clonazepam
toxicity or overdose (may induce seizures in pts with hx of seizure do or who are on
tricyclic antidepressants).

Antidotes:

Drug Interactions: ETOH, antidepressants, antihistamines, other benzodiazepines, & opiod

analgesics- concurrent use results in ↑CNS depression. Cimetidine, hormonal
contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propoxyphene,
 Tracey Spanbauer 2

propranolol, or valproic acid may ↓ metab of clonazepam, ↑ its actiond. May ↓ efficacy of
levodopa. Rifampin or barbiturates may ↑ metab &↓ effectiveness of clonazepam. Sedative
effects may be ↓ by theophylline, May ↑ serum phenytoin levels. Phenytoin may ↓ serum
clonazepam levels. ** Concomitant use of kava kava, valerian, or chamomile can ↑ CNS
depression.

Client Instructions: Instruct pt take med as directed. Take missed dose within 1 hr or
omit; don’t double dose. Abrupt withdrawal may cause status epileptics, tremors, n/v &
abdominal & muscle cramps. May cause drowsiness or dizziness avoid driving until know
response to drug. Avoid take with ETOH or other CNS depressants. Advise pt notify health
care prof. of med regimen prior to tx or surgery. Notify MD of unusual tiredness, bleeding,
sore throat, fever, clay-colored stools, yellowing of skin, or behavioral changes. Pt should
carry id that describing ds process & med regimen. Follow-up care important to determine
effectiveness of med regimen. Usually prescribed short-term and not cure underlying
probs. Advise to participate in psychotherapy to address anxiety probs. Teach other
methods of relaxation and advise not to share med with others.

Nursing Considerations: Observe & record intensity, duration & location of seizure
activity. Assess degree & manifestations of anxiety. Assess need for continued tx regularly.
Assess pt for drowsiness, unsteadiness, etc rt CNS depression. Monitor labs.