Long-acting·Neurology - Sedatives & Hypnotics

CLONazepam

Epilepsy (myoclonic, absence, focal), severe panic disorder

Authority requiredPBSBENZORivotril, Paxam2 mg tablet+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

8 mg/day

Half-life

20-50 h

Caution: Potency

HIGH

Caution: Dependence

HIGH RISK

Cautions

Avoid / Cautions

Severe respiratory insufficiency, Myasthenia Gravis, severe hepatic failure. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, long-acting benzodiazepine. Exhibits profound anticonvulsant and anxiolytic properties. Less sedating than diazepam but carries a massive risk of physical dependence.

Clinical Focus

0.5 mg of Clonazepam is roughly equivalent to 10 mg of Diazepam. Do not miscalculate the potency.

Bottom Line

Clonazepam is a long-acting benzodiazepine for epilepsy and panic disorder, but has high dependence potential and abrupt withdrawal can cause life-threatening seizures.

Formulation & Access

Brand Names

Rivotril, Paxam

Oral Routes

Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL).

Parenteral

Ampoules (1 mg/1 mL) for IV use.

Prescribing & PBS

Authority Required (PBS) for epilepsy. Private for anxiety.

Indications & Use

Primary

PBSTGA

Epilepsy (myoclonic, absence, focal), severe panic disorder.

Off-Label

OFF

REM sleep behavior disorder, severe acute mania, restless legs syndrome.

Clinical Place

Preferred benzo for seizure prevention and chronic panic disorder due to stable blood levels (long half-life prevents inter-dose withdrawal).

Quick reference

Class & Role

Long-acting — Highly potent, long-acting benzodiazepine.

Route / Formulation

Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL). (Rivotril, Paxam)

Usual Dose & Max

PO 0.5-1 mg BD. Max 4 mg/day.

Key Indication Doses

Panic Disorder: PO 0.5-1 mg BD. Max 4 mg/day. Epilepsy / Myoclonus: PO 0.5 mg TDS. Titrate up slowly based on response. Max 8 mg/day. Status Epilepticus: IV 1 mg STAT slow push (Often used as second-line to Diazepam/Midazolam).

Best Uses

Clonazepam is a long-acting benzodiazepine for epilepsy and panic disorder, but has high dependence potential and abrupt withdrawal can cause life-threatening seizures.

Key Risks

Neurological: Severe physiological dependence, terrifying withdrawal seizures if stopped abruptly. HIGH — Ataxia, cognitive blunting, somnolence. Respiratory: Respiratory depression (especially if mixed with opioids).

Key Interactions

Opioids, Alcohol (Fatal respiratory arrest). CYP3A4 inhibitors (Clarithromycin, Ketoconazole) spike clonazepam levels.

Monitoring

Monitor for sedation and ataxia. High falls risk on the ward. No specific routine laboratory tests required.

Clinical Pearl

Because of its 50-hour half-life, the drug takes up to 10 days to reach steady-state. If you increase the dose every 2 days because 'it isn't working', the patient will suddenly fall into a coma on day 8 when the drug finally stacks up.

Access

Authority requiredRivotril, Paxam2 mg tablet

Brand: Rivotril, Paxam
PBS status: Authority required
Formulation: Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Long-acting·Neurology - Sedatives & Hypnotics

CLONazepam

Epilepsy (myoclonic, absence, focal), severe panic disorder

Authority requiredPBSBENZORivotril, Paxam2 mg tablet+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

8 mg/day

Half-life

20-50 h

Caution: Potency

HIGH

Caution: Dependence

HIGH RISK

Cautions

Avoid / Cautions

Severe respiratory insufficiency, Myasthenia Gravis, severe hepatic failure. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, long-acting benzodiazepine. Exhibits profound anticonvulsant and anxiolytic properties. Less sedating than diazepam but carries a massive risk of physical dependence.

Clinical Focus

0.5 mg of Clonazepam is roughly equivalent to 10 mg of Diazepam. Do not miscalculate the potency.

Bottom Line

Clonazepam is a long-acting benzodiazepine for epilepsy and panic disorder, but has high dependence potential and abrupt withdrawal can cause life-threatening seizures.

Formulation & Access

Brand Names

Rivotril, Paxam

Oral Routes

Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL).

Parenteral

Ampoules (1 mg/1 mL) for IV use.

Prescribing & PBS

Authority Required (PBS) for epilepsy. Private for anxiety.

Indications & Use

Primary

PBSTGA

Epilepsy (myoclonic, absence, focal), severe panic disorder.

Off-Label

OFF

REM sleep behavior disorder, severe acute mania, restless legs syndrome.

Clinical Place

Preferred benzo for seizure prevention and chronic panic disorder due to stable blood levels (long half-life prevents inter-dose withdrawal).

Quick reference

Class & Role

Long-acting — Highly potent, long-acting benzodiazepine.

Route / Formulation

Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL). (Rivotril, Paxam)

Usual Dose & Max

PO 0.5-1 mg BD. Max 4 mg/day.

Key Indication Doses

Best Uses

Clonazepam is a long-acting benzodiazepine for epilepsy and panic disorder, but has high dependence potential and abrupt withdrawal can cause life-threatening seizures.

Key Risks

Key Interactions

Opioids, Alcohol (Fatal respiratory arrest). CYP3A4 inhibitors (Clarithromycin, Ketoconazole) spike clonazepam levels.

Monitoring

Monitor for sedation and ataxia. High falls risk on the ward. No specific routine laboratory tests required.

Clinical Pearl

Access

Authority requiredRivotril, Paxam2 mg tablet

Brand: Rivotril, Paxam
PBS status: Authority required
Formulation: Tablets (500 mcg, 2 mg). Oral liquid drops (2.5 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.