Uses
Seizure Disorders
Prophylactic management of Lennox-Gastaut syndrome and akinetic and myoclonic seizures.
Management of absence seizures in patients unresponsive to succinimides.
Some evidence of success in the management of refractory seizures†, including partial seizures with complex symptomatology and other partial seizures and some cases of infantile spasms†.
Useful in some patients with tonic-clonic seizures†.
Panic Disorder
Treatment of panic disorder with or without agoraphobia.
Catatonia
Also has been used for treatment of acute catatonic reactions†, whether associated with schizophrenia or other conditions.
Akathisia
May be helpful in patients experiencing akathisia† while receiving antipsychotic drugs (e.g., for management of schizophrenia).
Dosage and Administration
General
- Adjust dosage carefully and slowly according to individual requirements and response.
- Withdraw clonazepam slowly; avoid abrupt discontinuance, especially during long-term, high-dose therapy, to avoid precipitating seizures, status epilepticus, or withdrawal symptoms. During withdrawal of clonazepam in patients with seizure disorders, simultaneous substitution of another anticonvulsant may be indicated.
Administration
Oral Administration
Administer orally as conventional or orally disintegrating tablets.
Administer in 3 equally divided doses for the treatment of seizure disorders; if doses are not equally divided, give the largest dose at bedtime.
Administer in 2 equally divided doses for the management of panic disorder; alternatively, administer the entire dosage at bedtime to reduce the inconvenience of somnolence.
Conventional Tablets
Swallow tablet whole with water.
Orally Disintegrating Tablets
Just prior to administration, remove blister from aluminum pouch; with dry hands, peel open blister package, place orally disintegrating tablet in mouth to dissolve, and swallow with or without water.
Dosage
Pediatric Patients
Seizure Disorders
Oral
Infants and children <10 years of age or weighing <30 kg: Initially, 0.01–0.03 mg/kg daily; initial dosage should not exceed 0.05 mg/kg daily given in 2 or 3 divided doses.
Increase dosage by no more than 0.5 mg every third day until seizure control is achieved with minimal adverse effects. Maintenance dosage of 0.1–0.2 mg/kg daily.
Children ≥10 years of age or weighing ≥30 kg: Initial dosage should not exceed 1.5 mg daily given in 3 divided doses.
Increase dosage in increments of 0.5–1 mg every third day (up to a maximum dosage of 20 mg daily) until seizure control is achieved with minimal adverse effects.
Adults
Seizure Disorders
Oral
Initial dosage should not exceed 1.5 mg daily given in 3 divided doses. Increase dosage in increments of 0.5–1 mg every third day (up to a maximum dosage of 20 mg daily) until seizure control is achieved with minimal adverse effects.
Panic Disorder
Oral
Initially, 0.25 mg twice daily. After 3 days, increase dosage to usual maintenance dosage of 1 mg daily.
Some clinicians recommend dosages of 1–2 mg daily. Certain patients may benefit from dosages up to 4 mg daily. In such cases, increase dosage by 0.125–0.25 mg twice daily every 3 days until panic disorder is controlled with minimal adverse effects.
Discontinue therapy gradually by decreasing the dosage in increments of 0.125 mg twice daily every 3 days until the drug is completely withdrawn.
Prescribing Limits
Pediatric Patients
Seizure Disorders
Oral
Maximum 0.2 mg/kg daily.
Adults
Seizure Disorders
Oral
Maximum 20 mg daily.
Panic Disorder
Oral
Maximum 4 mg daily.
Special Populations
Geriatric Patients
Initiate therapy at low dosage and observe closely.
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