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| Clonazepam 1 mg (30 tablets) |
1 mg |
30 tablets |
$ |
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| Clonazepam 2 mg (30 tablets) |
2 mg |
30 tablets |
$ |
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| USES |
| Clonazepam 2mg 90 tabs |
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| HOW TO TAKE THIS MEDICATION |
| Alone or as an adjunct in the management of myoclonic and akinetic seizures and petit mal variant (Lennox-Gastaut syndrome). May also be of some value in patients with absence spells (petit mal) who have failed to respond to succinimides.
Up to nearly 33% of the patients in some studies have shown a loss of anticonvulsant activity, often within the first 3 months of clonazepam administration. In some cases, dosage adjustment may re-establish efficacy.
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| SIDE EFFECTS |
| The most frequently occurring adverse reactions to clonazepam are referable to CNS depression. Drowsiness occurs in approximately 50% of patients and ataxia in approximately 30%. In some cases, these may diminish with time. Behaviour problems have been noted in approximately 25% of patients and increased salivation in 7%.
Others, listed by system, are:
CNS:
Alterations in behaviour, which have been variously reported as aggressiveness, argumentative behaviour, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness and confusion. These behavioural reactions are particularly likely to occur in patients with a prior history of psychiatric disturbances and are known to occur in patients with chronic seizure disorders.
Other adverse reactions involving the CNS have included nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, insomnia, and diplopia. Isolated reports of akinesia, hemiparesis, tremor, hypotonia, headache and choreiform movements have been received. Minor changes in EEG patterns specifically low-voltage fast activity.
Gastrointestinal:
Increased salivation, nausea, vomiting, anorexia, constipation, diarrhea, encopresis, dry mouth, increased appetite, abdominal pain, hepatomegaly.
Genitourinary:
Rare instances of dysuria, nocturia, incontinence, urinary retention, enuresis.
Integumentary:
Nonspecific erythematous, papular and maculopapular rashes, swelling of the face and eyelids, urticaria, pruritus. Hirsutism and hair loss have also been reported, but drug relationship has not been established.
Musculoskeletal:
Muscle weakness, low back pain.
Respiratory:
Hypersecretion in the upper respiratory passages, rhinorrhea, dyspnea, respiratory depression.
Hematopoietic:
Anemia, leukopenia (WBC below 4000/mm(3)), thrombocytopenia, eosinophilia.
Liver function:
Slight, transient elevations of transaminase and alkaline phosphatase.
Miscellaneous:
Palpitations, coated tongue, dehydration, fever, lymphadenopathy, weight gain or loss, changes in libido, gynecomastia, hallucinations, dysdiadochokinesis, coma, aphonia.
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| PRECAUTIONS |
| Pregnancy:
Recent reports indicate an association between the use of anticonvulsant drugs and an elevated incidence of birth defects in children born to epileptic women taking such medication during pregnancy. The incidence of congenital malformations in the general population is regarded to be approximately 2%; in children of treated epileptic women this incidence may be increased 2 to 3 fold. The increase is largely due to specific defects, e.g., congenital malformations of the heart, and cleft lip and/or palate. Nevertheless, the great majority of mothers receiving anticonvulsant medications deliver normal infants.
Data are more extensive with respect to phenytoin and phenobarbital, but these drugs are also the most commonly prescribed anticonvulsants. Some reports indicate a possible similar association with the use of other anticonvulsants, including trimethadione and paramethadione. However, the possibility also exists that other factors, e.g., genetic predisposition or the epileptic condition itself may contribute to or may be mainly responsible for the higher incidence of birth defects.
Anticonvulsants should not be discontinued in patients in whom the drug is administered to prevent major seizures, because of the strong possibility of precipitating status epilepticus with attendant hypoxia and risk to both the mother and the unborn child. With regard to drugs given for minor seizures, the risk of discontinuing medication prior to or during pregnancy should be weighed against the risk of congenital defects in the particular case and with the particular family history.
Epileptic women of childbearing age should be encouraged to seek professional counsel and should report the onset of pregnancy promptly to their physician. Where the necessity for continued use of antiepileptic medication is in doubt, appropriate consultation might be indicated.
In a reproductive study in rabbits, clonazepam administration was associated with an increased incidence of cleft palate and other anomalies at 2 dose concentrations. Accordingly, clonazepam should be used in women of childbearing potential only when the expected benefits to the patient warrant the possible risk to a fetus.
Lactation:
Mothers receiving clonazepam should not breast feed their infants.
Children:
Because of the possibility that adverse effects on childhood physical or mental development could become apparent only after years, a risk-benefit consideration of the long-term use of clonazepam is important in pediatric patients.
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| OVERDOSE |
| Symptoms:
The cardinal manifestations of overdosage are drowsiness and confusion, reduced reflexes and coma. There are minimal effects on respiration, pulse and blood pressure, unless the overdosage is extreme. Patients have recovered from dosages of up to 60 mg without special treatment. When the effects of the drug overdosage begin to wear off, the patient exhibits some jitteriness and over stimulation.
Treatment:
Gastric lavage may be beneficial if performed soon after ingestion of clonazepam. Supportive measures should be instituted as indicated: maintenance of an adequate airway, i.v. fluids and monitoring of pulse, blood pressure and respiration. CNS stimulants and vasopressors may be used if necessary. Dialysis appears to be of no value.
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| STORAGE |
| Clonazepam 2mg 90 tabs |
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